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PubMed1992

[The value of physical therapy with VRP 1-Desitin ("Flutter")].

UNLABELLED: Preliminary examinations with an innovative device for physiotherapy, VRP 1-Desitin ("Flutter"), in patients suffering from chronic mucus retention and bronchial collapse gave encouraging results. Therefore, we tried to confirm these findings and to evaluate the use of this new physiotherapy. It is based on oscillations of air in the respiratory tract during expiration (rate about 2 to 32 Hertz) diminishing adhesiveness of bronchial mucus and bronchial collapse. Pressure and flow changing depend on the position of mouth-piece and effort of breathing. In order to establish the efficiency of the VRP 1 a comparing investigation was initiated. 20 patients with cystic fibrosis, aged 7 to 28 years, performed physiotherapy with VRP 1 and autogenic drainage (AD), respectively, in a randomized order one after another, each physiotherapy taking twenty minutes. The expectorated sputum was weighed by means of a precision balance. Mean values during VRP 1 treatment were 5.0 g (range 0 to 12.0 g), during AD 4.8 g (range 0 to 11.7 g). There was no statistical difference (p < 0.05). The results were not influenced by the order of physiotherapy. CONCLUSIONS: VRP 1 physiotherapy is as effective as AD with respect to sputum elimination. In opposite to other methods not requiring a helping person it is simple to teach and to learn. It may be performed by young children (> or = 3 years) and adults, also in combination with inhalation. Thus, VRP 1 appears to be a real enrichment in physiotherapy.

Adolescent↗
PubMed1992

[Bronchoscopy for initial care following severe thoracic trauma--basically indicated?].

UNLABELLED: The study objective was to determine the usefulness of routine early (within 24 h after admission) and late (on the 3rd posttraumatic day) flexible fiberoptic bronchoscopy in patients with severe chest trauma. METHODS: By history, physical examination, and radiologic findings, we identified 15 consecutive patients, all of whom were anaesthetized, orally intubated, and mechanically ventilated. There was no change in ventilation, including FIO2, for bronchoscopy. The patients had continuous cardiovascular monitoring and peripheral pulse oximetry. The bronchoscope was inserted through a tight-fitting side port at the endotracheal tube connector. Pulse rate, mean arterial pressure, and arterial blood gases were recorded before, 1 min after, and 10 min after bronchoscopy, as were intracranial pressure (ICP) in 7 patients with an ICP probe (early bronchoscopy only) and the duration of the examination. Statistical significance was tested by means of the Wilcoxon test for correlating samples. Significance was assumed at P less than 0.05 in a two-sided test. RESULTS: Early bronchoscopy revealed two bronchial avulsions, two aspirations, and ruled out one suspected aspiration. Late bronchoscopy showed plugging of at least 3 segmental bronchi by clots in 4 patients, none of whom was able to expectorate effectively. In general, changes in the observed vital parameters were minimal. There was a significant but clinically irrelevant increase in mean pulse rate before and 1 min after early bronchoscopy. DISCUSSION: We conclude that bronchoscopy should always be considered in patients with severe chest trauma, the decision being based on typical radiological findings as well as clinical signs and symptoms. Given the proper indication, bronchoscopy supplies valuable information at minimal risk to the patient.

Adult↗
PubMedDate not supplied

[Inhalation therapy with sulphur water in ORL: clinical-experimental study].

OBJECTIVE: Several clinics and experimental researches have highlighted the utility of the inhalant mineral therapy in numerous diseases to load of the tall and low respiratory streets. Aim of the our clinical-experimental study has been that of appraise "to brief term" the curative effects and the adverse reactions of a thermal inhalant treatment with sulphur water in the care of diseases ORL apparatus (laryngitis, pharyngitis, rhinitis, rhinosynusitis), appraise the course of some End points to distance. PATIENT AND METHODS: The study has been channel on a champion of 83 subjects of which 45 of male sex and 38 of female sex with age serious equal average to 53 years +/- 2.6. The subjects of the examined champion that affections from diseases inflammatory chronic of ORL relevance (laryngitis, pharyngitis, rhinitis) were subjected to a cycle of sulphur mineral inhalant therapy disbursed with businesslike individual of inhalations to bud of vapor to the T of 38 degrees C to 20 cm from the face with duration of 10 min, follows from aerosol for likewise minutes. To the beginning and at the end of the sulphur mineral inhalant cycle has been valued the subjective symptomatology susceptible of amelioration, some End Points to distance and the adverse reactions. RESULTS: The data seem to highlight the end cycle curative sulphur mineral inhalant an significant (P < 0.05) amelioration of best part of the symptoms examined like cough, nasal itch, expectoration [etc]. The analysis of the End Points to advised Distance show an significant (P < 0.05) progressional diminution of such indicators to succession of the annual continuity of the inhalant sulphur mineral treatment. CONCLUSIONS: The results of such research seem to demonstrate that the inhalant sulphur mineral therapy can induced notable benefit in different inflammatory chronic diseases of ORL relevance in peculiar in the first ten of life with a positive relapse on some End Points to distance and an excellent local and systemic tolerable.

Female↗
PubMedDate not supplied

Invasive pulmonary aspergillosis: A study of 39 cases at autopsy.

BACKGROUND: Aspergillus is a common cause of invasive mycosis, especially in immunocompromised or immunosuppressed individuals. AIMS: To study the incidence of invasive pulmonary aspergillosis and evaluate the predisposing factors and clinico-pathological manifestations. SETTINGS AND DESIGN: Retrospective analysis of autopsy material from a tertiary care hospital. MATERIAL AND METHODS: All autopsies performed over a 12-year period were reviewed and cases with invasive aspergillosis were analysed with respect to their clinical presentation, predisposing factors, gross and histological features, complications and causes of death. RESULTS: Among a total of 20475 autopsies performed in 12 years, 39 patients (0.19 %) had invasive pulmonary aspergillosis. There were 28 males and 11 females. Their ages ranged from five months to 67 years. Dyspnoea, fever, cough with mucopurulent expectoration, chest pain and haemoptysis were commonly encountered symptoms. Forty-one per cent of the patients had no respiratory symptoms. Fungal aetiology was not entertained clinically in any of the patients. The major underlying conditions were prolonged antibiotic therapy, steroid therapy, and renal transplantation, often associated with underlying lung diseases. Pneumonia, abscesses, vascular thrombosis and infarction were common findings at autopsy. Antecedent tuberculosis, mucormycosis, Pneumocystis carinii pneumonia and Cytomegalovirus infection were also present. In most cases, death was related to extensive pulmonary involvement or fungal dissemination. CONCLUSION: A diagnosis of invasive pulmonary aspergillosis should always be borne in mind whenever one is dealing with recalcitrant lung infections even with subtle immunosuppression. Radiological investigations and serologic markers can be utilised for confirmation and prompt therapy.

Adolescent↗
PubMed2004

Detection of Mycobacterium tuberculosis by a polymerase chain reaction colorimetric dot-blot assay.

SETTING: A public health laboratory in a tuberculosis-endemic region in Brazil. OBJECTIVE: To evaluate the accuracy of a combined polymerase chain reaction (PCR) colorimetric dot-blot protocol for Mycobacterium tuberculosis detection in clinical samples in a public health laboratory. DESIGN: Eighty clinical samples (13 cerebrospinal fluid, 31 induced sputum, 17 expectorated sputum, eight bronchoalveolar lavage and 11 pleural fluid) were assayed with the developed protocol. The accuracy of polymerase chain reaction (PCR) dot-blot methodology was compared to PCR agarose gel electrophoresis (PCR-AG) using as a gold standard the bacteriological result (culture and biochemical identification) combined with clinical follow-up. One internal region of the IS6110 repetitive element of the M. tuberculosis complex was selected for amplification and the amplified product transferred to nylon membranes to be detected by biotinylated DNA probe. RESULTS: Overall sensitivity and specificity obtained were respectively 90% and 97% for PCR-AG and 95% and 97% for the PCR dot-blot. Among the 56 respiratory specimens, the sensitivity and specificity results for PCR-AG were respectively 88% and 95%, and for PCR dot-blot they were 94% and 95%. Among the 24 non-respiratory specimens the sensitivity and specificity results were respectively 83% and 100% for PCR-AG, and 100% and 100% for the PCR dot-blot protocol. CONCLUSION: The results demonstrated that the PCR dot-blot assay may be helpful in the diagnosis of tuberculosis, and feasible even in resource-poor countries.

Blotting, Southern↗
PubMed2003

[Nebuliser therapy].

We use the nebuliser therapy to achieve rapid improvement in patients with acute airway limitation. Besides, this drug is effective in asthmatic children, in elderly patients and in patients with end-stage disease who need palliative care. Nowadays nebuliser therapy is used not only for bronchodilatation but also for antibiotic and expectoration treatment. Although nebuliser therapy provides a rapid and effective treatment in airway limitation, the patients who receive home nebuliser therapy may suffer from severe and incurable infections if the hygienic conditions are not achieved. Therefore, the indications of nebuliser therapy should be precisely determined and special care should be given in the choice of the patients who will receive nebuliser therapy.

Administration, Inhalation↗
PubMed2004

Physiologic evidence for the efficacy of positive expiratory pressure as an airway clearance technique in patients with cystic fibrosis.

BACKGROUND AND PURPOSE: Individuals with cystic fibrosis (CF) have large amounts of infected mucus in their lungs, which causes irreversible lung tissue damage. Although patient-administered positive expiratory pressure (PEP) breathing has been promoted as an effective therapeutic modality for removing mucus and improving ventilation distribution in these patients, the effects of PEP on ventilation distribution and gas mixing have not been documented. Therefore, this preliminary investigation described responses in distribution of ventilation and gas mixing to PEP breathing for patients with moderate to severe CF lung disease. SUBJECTS AND METHODS: The effects of PEP breathing on ventilation distribution, gas mixing, lung volumes, expiratory airflow, percentage of arterial blood oxyhemoglobin saturation (SpO(2)), and sputum volume were studied in 5 patients with CF (mean age=18 years, SD=4, range=13-22) after no-PEP, low-PEP (10-20 cm H(2)O), and high-PEP (>20 cm H(2)O) breathing conditions. Single-breath inert gas studies and lung function tests were performed before, immediately after, and 45 minutes after intervention. Single-breath tests assess ventilation distribution homogeneity and gas mixing by observing the extent to which an inspired test gas mixes with gas already residing in the lung. RESULTS: Improvements in gas mixing were observed in all PEP conditions. By 45 minutes after intervention, the no-PEP group improved by 5%, the low-PEP group improved by 15%, and the high-PEP group improved by 23%. Slow vital capacity increased by 1% for no PEP, by 9% for low PEP, and by 13% for high PEP 45 minutes after intervention. Residual volume decreased by 13% after no PEP, by 20% after low PEP, and by 30% after high PEP. Immediate improvements in forced expiratory flow during the middle half of the forced vital capacity maneuver (FEF(25%-75%)) were sustained following high PEP but not following low PEP. DISCUSSION AND CONCLUSION: This study demonstrated the physiologic basis for the efficacy of PEP therapy. The results confirm that low PEP and high PEP improve gas mixing in individuals with CF, and these improvements were associated with increased lung function, sputum expectoration, and SpO(2). The authors propose that improvements in gas mixing may lead to increases in oxygenation and thus functional exercise capacity.

Adolescent↗
PubMed1992

Bronchitis mimicking opportunistic lung infection in patients with human immunodeficiency virus infection/AIDS.

Purulent bronchitis was identified in 19 of 422 patients undergoing fiberoptic bronchoscopy during a 32-month period because of suspicion of an opportunistic lung infection complicating acquired immunodeficiency syndrome or human immunodeficiency virus infection. Five patients had Pneumocystis carinii pneumonia, but other opportunistic lung infections were excluded in the remaining 14 patients. Characteristics of these 14 patients included fever (greater than 38.3 degrees C), cough, and dyspnea in 14 of 14 patients; purulence of expectorated sputum (11/14); and widened alveolar-arterial oxygen gradient (13/14). Rapid (2 +/- 1.4 days) clinical response (defervescence and resolution of pulmonary symptoms) occurred with antibiotic therapy in 10 of 14 patients. In three patients, there was no improvement, and adult respiratory distress syndrome developed. Bacterial isolates from bronchoalveolar lavage included Streptococcus viridans (n = 12), Haemophilus influenzae (n = 7), Staphylococcus aureus (n = 3). Roentgenographic features of bronchiectasis were present in seven patients. Differential cell counts revealed greater than 50% neutrophils in the bronchial washings of all patients with purulent bronchitis. Neutrophil percentages in bronchoalveolar lavage were as follows: patient with purulent bronchitis without P carinii pneumonia (n = 14), 54.53% +/- 29.18%; patients with purulent bronchitis and concomitant P carinii pneumonia (n = 5), 62% +/- 31.9%. In a control group of 17 patients with P carinii pneumonia who did not have purulent bronchitis, the neutrophil percentage was 6.8% +/- 6.17% (p = less than 0.00001, t-test). Purulent bronchitis appears to be a distinct, treatable entity in patients with HIV infection and may accompany bacterial pneumonia, bronchiectasis, and P carinii pneumonia.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Use of image analysis in determining masticatory efficiency in patients presenting for immediate dentures.

Image analysis was used to determine masticatory efficiency and performance before and after placement of immediate dentures. Sections of cored carrot were used as the test food and the particle size of chewed expectorated food was measured using image analysis. Measurements were shown to be accurate and reproducible. Masticatory function of immediate-denture patients was also compared with a similar number of dentate individuals and experienced complete-denture wearers. Dentate subjects were significantly (P less than .01) more efficient at masticating the test food than were the complete- or immediate-denture wearers. The new method of measurement removes the necessity for the unpleasant and unhygienic sieving process previously used in this type of study.

Denture, Complete, Immediate↗
PubMedDate not supplied

Airway obstruction in bronchiectasis and its reversibility--a study of 38 patients.

Thirty-eight patients (20 males and 18 females) with bronchiectasis were studied for the evidence of airway obstruction and its reversibility in response to subcutaneous terbutaline. There was an improvement in VC (8.56%), FEV1 (6.36%), PEFR (15%) and PEF 25-75% (18%) respectively. The difference being statistically significant in VC and highly significant in FEV1, PEFR and FEF25-75 as compared to initial values and in 6 patients the improvement in FEV1 was more than 15%. The improvement in airway obstruction was not related to the character of expectoration. It is suggested that all the patients of bronchiectasis should be assessed for the reversibility of airway obstruction and those showing a reversible pattern be treated accordingly.

Adult↗
PubMed2004

[The value of bronchial lavage in patients with radiologically suggestive pulmonary tuberculosis with no sputum production and gastric lavage smear negativity].

We assessed whether acid-fast bacilli (AFB) investigation in bronchial lavage (BL) contributes to diagnosis in patients with gastric lavage smear negative and radiologically suggestive of pulmonary tuberculosis. Eighty-three patients were recruited for the study, five cases were excluded due to diagnosis of inactive disease or non-tuberculosis disease. The remaining 78 patients were evaluated. All patients were unable to expectorate sputum and their gastric lavages were negative for AFB. BL was performed for the detection of Mycobacterium tuberculosis in all patients. Bronchial lavage smear were positive in 15.4%(12 patients). BL culture positivity was 58.3%(42 patients) and gastric lavage culture positivity was 33.3%(26 patients). Eighteen cases had both gastric lavage and BL culture positivity. BL culture was positive in 24 cases who had gastric lavage culture negativity. We suggest that in cases who do not produce sputum and whose gastric lavage smears are negative; BL should be performed for diagnosis of pulmonary tuberculosis.

Adult↗
PubMed2003

Microbial etiologies in community acquired pneumonia (CAP).

The objective of the study was determination of bacterial etiologic factors, including antibiotic atypical pathogens, of community acquired pneumonia (CAP) in adults and of sensitivity of isolated strains. The examined group comprised 50 patients with clinical and x-ray image of pneumonia. Patients' expectoration sputum was analyzed. Amongst all isolated bacteria, the most frequent were Staphylococcus aureus - 17.9%, Haemophilus parainfluenzae - 12.5% and H. influenzae - 8.9%. Identification of Corynebacterium pseudodiphtheriticum in 8.9% of CAP cases drew our particular attention. Staphylococcus aureus was the least antibiotic sensitive microorganism. In the majority of patients (26: 52%), serologic markers of chlamydial infection were determined. Pneumonia often results from mixed typical and atypical flora infection. High percentage of atypical pathogens in the examined material suggests the necessity to administer intracellularly acting antibiotics.

Adult↗
PubMed1992

[Incidence and diagnosis of pneumococcal pneumonias requiring admission to hospital].

A prospective investigation of patients admitted to the local hospital during a period of one year was undertaken. A total of 107 patients participated. 50% of the cases of pneumonia were found by Streptococcus pneumoniae. The diagnosis was established partly by demonstration of antigens and increase in antibody titre and also employing the traditional methods: Blood culture, microscopic examination and culture of the expectorate or tracheal secretion. 70% of the patients were over the age of 60 years. The mortality was found to be 17%. The difficulties in etiological investigations of infections in the lower respiratory tract are discussed.

Adult↗
PubMed1992

[Cytologic examinations during bronchial endoscopy. Bronchial brushing and aspiration].

Bronchial cytology has become an essential diagnostic means in lung pathology for the diagnosis and typing of primary or secondary lung cancers. Bronchial cytology, initially consisting in the study of expectorations, has become increasingly interesting with the development of flexible fiberendoscopes, which allow the visual exploration of areas of the lungs as far down as the subsegmental bronchi. The effectiveness of this type of cytology applied to detected and located lesions accounts for the development of aspiration and brushing. However, the obtention of good cytological results primarily depends on the operator's and nurse's experience, as well as on the quality of the preparation of the slides and of their interpretation in the laboratory.

Biopsy↗
PubMed2004

[Temporal organization of external respiratory function in elderly patients with chronic obstructive lung disease].

The clinical course and the circadian, circaseptan, and circasemiseptan chronostructure of external respiratory function (ERF) were studied in 26 elderly patients with chronic obstructive lung diseases before and after routine therapy (RT). ERF was studied on a meta-test spirograph (Russia) and a Ferraris medical peak flowmeter (UK). The values of ERF and bronchial patency were measured every 4 hours within 7 days before and after 10-day RT. The latter included euphylline, expectorants, and antibacterial drugs, if indicated. The patients also use "on-demand" dosage aerosol inhalators not more than 3-5 times a day. The chronobiological data were analyzed by the averaged group cosinor test described by F. Halberg. The results of the study made it possible to detect the impaired temporary organization of ERF and bronchial patency, the phenomena of external and internal desynchronism both prior to and following RT. It clinical effect occurred on day 5.5 after RT. Before RT, circadian variations were found in respiratory volume (RV), respiratory minute volume (RMV), vital capacity (VC), forced expiratory value per sec (FEV1), the Tiffeneau test, and peakflowmetry. After RT, they remained other than variations in RV. The average daily values of VC, FEV1, Tiffeneau test, PO2, and KIO2 statistically significantly increased. The increases of MESORs and other indices tended to be significant. Circasemiseptan variations were found in RV, VC, and FEV1 before RT. After treatment, these were detected in respiration rate (RR), RMV, VC, and KIO2. The MESORs of RMV, VC, FEV1, and KIO2 statistically significantly increased. Prior to and following RT, there were virtually no 7-day (circaseptan) variations, other than those in RR before therapy. The MESORs of VC, FEV1, MVL, and RD statistically significantly increased. The MESORs of other parameters of ERF tended to be significant. Thus, RT led to the improved circadian and circasemiseptan organization of ERF and, to a lesser degree, to that of circaseptan chronostructure of the parameters of ERF.

Aged↗
PubMed2004

Tracheomalacia associated with Mounier-Kuhn syndrome in the Intensive Care Unit: treatment with Freitag stent. A case report.

Tracheomalacia is a process characterized by softness of the supporting tracheal cartilages, by the extension of the posterior membranous wall and by reduction of the tracheal antero-posterior diameter. Exceptionally, tracheomalacia can be associated with tracheobronchomegaly or Mounier-Kuhn syndrome. Fibro-bronchoscopy represents the ''gold standard'' for diagnosis. The case of a 79-year-old male observed after hospitalization in a medical ward for chronic pulmonary obstructive disease (COPD) decompensation, and with basal left bronchopulmonary focus, is described. During this period, a progressive worsening of clinical conditions occurred, despite cortisone and antibiotic therapy, and the patient was transferred to the ICU for dyspnea, hypoxia, hypocapnia and with a diagnosis of pulmonary fibrosis. Bronchoscopy, performed during spontaneous breathing, revealed tracheomalacia which was responsible for tracheal dynamic complete stenosis during expiration and dynamic subtotal stenosis of the left primary bronchus in the first tract, together with sputum retention. Moreover, this investigation confirmed the diagnosis of tracheobronchomegaly already seen on CT. It was suggested to place a Freitag stent, since the insertion of another model would not have had enough chance of stability, due to the enormous extension of the tracheal lumen and could not have guaranteed good clearance of the secretions. Seven days after this intervention, performed in an outpatients' setting, the patient was dismissed from the ICU, without the help of O2, with good ventilation, saturation in line with his age and good expectoration.

Aged↗
PubMed2004

[Diagnosis and management of exacerbations and acute respiratory failure in patients with chronic obstructive pulmonary disease].

Acute episode of chronic obstructive pulmonary disease occurs in almost all patients, during which cough, expectoration and dyspnea increase. When the underlying disease is not severe and the acute episode not life-threatening, the term "exacerbation" is appropriate, and the patients can be managed at home. When the underlying disease is advanced and the acute episode possibly life-threatening, the terms of "acute respiratory failure" or "decompensation" can be used. These patients are most often admitted to the hospital, and at times to the intensive care unit. Bronchodilators and respiratory physiotherapy form the basis of the management of acute episodes of COPD. In severe cases, oxygen must be administered, and the decision of an hospitalisation considered. Antibiotics and corticosteroids shoud not be prescribed in a systematic manner. In the most severe cases, non-invasive ventilation must be accessible. The prevention of acute episodes of COPD is best achieved through tobacco cessation and influenza vaccine. Finally, an acute episode may be an opportunity to make a diagnosis of COPD if this has not been done before.

Acute Disease↗
PubMed2004

[Diffuse panbronchiolitis complicated by thymoma: a case report and a review of literature].

OBJECTIVE: To highlight the characteristics of diffuse panbronchiolitis (DPB). METHOD: One patient with DPB confirmed by thorocoscopic biopsy was described and relevant literatures were reviewed. RESULTS: DPB is a chronic lower respiratory tract disease common in Japanese, rare in China, characterized by infiltration of inflammatory cells around bronchioles. Although the etiology and precise mechanisms are under investigation, it is commonly hypothesized that heredity and immunity have a major role in DPB. Symptoms include cough, expectoration, and dyspnea after exercises. Pseudomonas aeruginosa is isolated from sputum in some cases. If left untreated, DPB progresses rapidly and has a poor prognosis if respiratory failure occurs. CONCLUSIONS: DPB should be included in the differential diagnosis of bilateral multiple pulmonary nodular shadows. Long-term, low-dose macrolide therapy may improve the prognosis through an anti-inflammatory effect.

Adult↗