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PubMedDate not supplied

Video-assisted thoracoscopic lobectomy for right middle lobe bronchiectasis.

The bronchiectasis process is irreversible, and only resection of the involved bronchiectatic segments offers the possibility of potential cure. We present our experience in video-assisted thoracoscopic lobectomy for localized right middle lobe bronchiectasis in 16 patients. From July 1994 to June 2002, we enrolled 16 patients with right middle lobe bronchiectasis. There were nine women and seven men, with a mean age of 39.7 years (range, 21-67 years). The mean duration of symptoms such as hemoptysis and chronic purulent productive cough was 7.3 years (range, 2-19 years). Surgical indications included repeat pulmonary infection with often abundant purulent, sometimes fetid, expectoration in eight patients (50%), frequent massive hemoptysis in four patients (25%), and both repeat pulmonary infection and hemoptysis in four patients (25%). During operation, all patients were placed in left lateral position under double-lumen intubated anesthesia. Three incisions were needed. One 1-cm incision for the camera port was created at the seventh intercostal space along the anterior axillary line and the other 1- and 4-cm incisions were created at the seventh and fifth intercostal spaces along the midclavicular line. Right middle lobectomy could be completed by use of either traditional or endoscopic instruments. The mean total operative time was 87 minutes (range, 60-110 minutes). The mean hospital stay was 6 days (range, 4-11 days). One patient suffered from a mild hemothorax complication that needed 10 days of pleural drainage. There was no surgical mortality in this study. The mean follow-up period was 45 months (range, 10-94 months). Overall, 14 (87.5%) patients were asymptomatic, and the other 2 (12.5%) obtained apparent symptomatic improvement after operation. Video-assisted thoracoscopic lobectomy for right middle lobe bronchiectasis is technically feasible using our approach and is potential safe in treating patients with localized right middle lobe bronchiectasis.

Adult↗
PubMed2004

[Screening for lung cancer].

Bronchial cancer is the ideal candidate for the application of screening strategies: it is a serious, frequent disease and its diagnosis is often delayed. Moreover, only the early stages of the disease offer high hopes of being cured. However, proof of the impact of screening has not been supplied either by X-ray or by cytological examination of expectorations, despite numerous open and subsequent randomised trials. Recently, the low dose scan has shown to be a technique far more sensitive than X-ray and capable of detecting early stage tumours. Nevertheless, it is also a barely specific examination revealing a great number of benign abnormalities and perhaps leading to futile examinations. Because of this, the eventual demonstration of the impact of the scan on the lung cancer mortality warrants the development of randomised trials.

Adult↗
PubMed2004

[A case of pharyngolaryngeal edema after posterior occipito-cervical operation].

A 70-year-old female developed respiratory failure due to pharyngolaryngeal edema after posterior occipito-cervical fusion. She had a history of total thyroidectomy with bilateral neck dissection for advanced thyroid cancer associated with multiple lung metastases. However, her general condition was good, and she was not in cachexia. Her pulmonary function test revealed %VC of 54% and %FEV1.0 of 79%. This posterior occipito-cervical fusion was necessary for pain relief. Twenty-four hours after surgery she suddenly showed dyspnea, requiring tracheal intubation, and was supported by mechanical ventilation. The pharyngolaryngeal edema was recognized with bronchoscopy from the lower larynx with arytenoid region to nasal choana. In several days she recovered from pharyngolaryngeal edema and was extubated. She was discharged from ICU after close observation for 24 hours after extubation. She developed respiratory distress again due to difficulty in sputum expectoration, resulting in emergency tracheostomy an the floor at midnight. In this case, pharyngolaryngeal edema may have been caused by disturbance of lymphatic flow due to posterior occipito-cervical fusion in a patient with a past history of bilateral neck dissection. We also reviewed the literature in this report.

Aged↗
PubMedDate not supplied

Lymphangioleiomyomatosis: a rare cause of breathlessness.

A 24-year-old female presented with complaints of cough with scanty expectoration, breathlessness on exertion and chest pain for the last three years. These symptoms had appeared during the 12th week of her third pregnancy. She was given anti-tuberculosis treatment at another hospital for nine months without any improvement in symptoms. Four years ago she had been diagnosed to have leprosy of borderline variety for which she had received treatment. On examination, she was tachypnoeic with a respiratory rate of 33 breaths per minute. She had clubbing and small, discrete and firm lymph nodes in the anterior cervical region. Chest examination revealed wheezing with bibasilar end-inspiratory crepitations.

Adult↗
PubMed2004

Bronchioloalveolar carcinoma masquerading as pneumonia.

Bronchioloalveolar carcinoma (BAC) is a relatively rare adenocarcinoma that typically arises in the lung periphery and grows along alveolar walls, without destroying the lung parenchyma. It is often multicentric and may arise from a previously stable scar. Because the parenchyma is preserved and because BAC may arise simultaneously in multiple lobes, the chest radiograph and symptoms (cough, chest pain, and sputum production) may be indistinguishable from pneumonia or other noninfectious inflammatory processes (eg, hypersensitivity pneumonitis or bronchiolitis obliterans). The clinician should suspect BAC if what otherwise appears to be pneumonia lacks fever or leukocytosis or does not respond to antibiotics. BAC accounts for 2.6-4.3 % of all lung cancers. On a radiograph, BAC often appears as a solitary nodule, but may also appear as a patchy, lobar or multilobar infiltrates, often with air bronchograms indistinguishable from pneumonia. Positron-emission tomography does not help distinguish BAC from pneumonia. Among BAC patients, 62% present without symptoms and with only an abnormal radiograph, whereas 38% present with symptoms of cough, chest pain, and sputum production. Bronchoscopy is usually normal. Preoperative diagnosis with transbronchial biopsy, bronchoscopic cytology examination, or expectorated sputum cytology is more common with the diffuse or multicentric forms. Cure depends on complete resection. A trial of antibiotics and reassessment of clinical findings is a reasonable approach, but biopsy or cytology is the only means of ruling in malignancy and ruling out other etiologies, so biopsy should always be considered when a presumed pneumonia does not respond to antibiotics. I saw a 61-year-old man whose initial diagnosis was pneumonia. He took a 10-day course of oral azithromycin, but his symptoms and chest radiograph were unchanged. A tomogram showed interstitial prominence and peripheral air-space disease in the right upper and lower lobes. Transbronchial biopsy of the right upper lobe showed Clara cells, with substantial atypia and various nuclear-cytoplasmic ratios. The underlying pulmonary architecture was preserved and no invasive component was seen. The diagnosis was changed to nonmucinous BAC. Pneumonectomy was successful and he was cancer-free for about 10 months, after which the cancer returned and from which he eventually died.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2004

[A case of bronchial ulcer due to infection by Mycobacterium abscessus].

We present a rare case of tracheobronchitis caused by Mycobacterium abscessus. The patient was a 79-year-old man with a previous history of tuberculosis. For smear examinations, he repeatedly expectorated many acid-fast bacilli. Bronchoscopic examination revealed the presence of ulceration on the lower end of the trachea and extending to the right main bronchus. Mycobacterial cultures were used to grow Mycobacterium abscessus. Following an antimicrobial regimen of clarithromycin, amikacin, and cefoxitin, the patient exhibited marked improvement. After initial multidrug therapy, the patient was placed on clarithromycin for 10 months. No relapse has occurred to date.

Aged↗
PubMed2004

[Acute exacerbation of chronic bronchitis: patients, antibiotherapy, and guidelines].

OBJECTIVE: The aim of this study was to compare antibiotic prescriptions made by general practitioners to French recommendations for the management of Acute Exacerbation of Chronic Bronchitis (AECB) referring to the patient's socio-demographic data, history of Chronic Bronchitis (CB), current episode management, and quality of life. METHODS: This cross-sectional study was made on 101 general practitioners. RESULTS: Four hundred eighteen patients were included: mean age: 66 +/- 12 years; male patients 71%; mean history of CB: 13 years; cardiac comorbidity: 45%; depression: 34%; obstructive ventilatory syndrome: 64%; respiratory functional test performed: 44%; FEV1 <35%: 10%. An antibiotic was prescribed in 95% of cases. 94% of treated patients were classified as type 1 or 2, according to Anthonisen's criteria: 85% of these presented with purulent expectoration. The classification used in French recommendations was applied in 364/418 patients, 79 had simple CB, 231 had moderate obstructive CB, 43 had severe obstructive CB. The antibiotic (AB) prescriptions concerned mostly group 2. Group 2 AB were over-prescribed in 70% of patients suffering from obstructive CB or simple CB. But group 2 AB were under-prescribed in 25% of patients suffering from severe obstructive CB. CONCLUSION: Group 1 AB prescriptions were compliant with Anthonisen's criteria in most cases but the choice of AB did not follow French recommendations, with an over-prescription of group 2 AB and a bad assessment of simple CB.

Adrenal Cortex Hormones↗
PubMed2004

[Surgical treatment of pulmonary tuberculosis].

The indications for the surgical treatment of pulmonary tuberculosis are mainly for multidrug-resistant tuberculosis (MDR-Tb). In Fukujuji Hospital there have been 91 pulmonary resections for 83 MDR-Tb cases during the past 20 years. Of those resections, upper lobectomies with or without partial resection of other lobes comprised 55%, segmentectomies 10%, and pneumonectomies 30%. The following major postoperative complications occurred: prolonged air leakages in 19%, empyema in 9%, and respiratory failure in 6%. However, there were no operative deaths. After pulmonary resection for MDR-Tb, immediate negative conversion rate of expectoration of tuberculous bacilli was 98%, reexpectoration rate of them was 12%, The final cure rate was 92%. Surgical treatment is worth consideration for the treatment of refractory pulmonary tuberculosis.

Humans↗
PubMed1992

[Infectious agents associated with exacerbations of chronic obstructive bronchopneumopathies and asthma attacks].

Infections of the respiratory airways are frequently responsible for exacerbations of chronic obstructive pulmonary disease (COPD) and attacks of asthma. However, the causal infectious agents in practice are rarely precisely identified. We have undertaken a prospective study with the aim of researching into the bacteria and viruses associated with these exacerbations. Forty-seven patients who were in hospital between 1987 and 1989 for attacks of asthma (13 episodes) or exacerbations of COPD (35 episodes) were included in this study. The microbiological analysis consisted of: 1) the bacteriology of expectorated material or the products aspirated by fibroscopy with direct examination, quantitative cytology and culture; 2) samples taken from the nasal airways to identify and isolate pneumotropic viruses and mycoplasma; 3) serial serology looking for antibodies against pneumotropic bacteria and viruses. One of more infectious agents were shown in 47% of the episode studies of which 57% were exacerbations of COPD and treated 23% attacks of asthma. In the cases COPD bacteria were identified in 13 cases including Haemophilus influenzae [3], Streptococcus pneumoniae [3], Pseudomonas aeruginosa [3]. Amongst the 14 viruses recovered, the influenza virus [8] and the respiratory syncytial virus (VRS) [4] predominated. In 14 cases of acute asthma only 4 infectious agents were shown; Mycoplasma pneumoniae, influenza A, VRS and parainfluenza virus. The influenza virus was the agent most frequently discovered (26%) during the course of exacerbation of COPD and of asthma.

Bacteria↗
PubMed2005

Comparison of two techniques of sputum induction in the diagnosis of pulmonary tuberculosis.

SETTING: Specialised tuberculosis out-patient clinic covering a population of 350 885. OBJECTIVES: To compare two techniques, ultrasonic nebuliser (UN) and Venturi-type face mask nebuliser (VFMN), for obtaining sputum in patients suspected of having active pulmonary tuberculosis (PTB) and who cannot expectorate, and to analyse the usefulness and cost of sputum induction with UN in a specialised medical practice. DESIGN: Prospective study from October 1997 until March 2000. RESULTS: Of 94 subjects who completed all tests, at least one sample of sputum was obtained from 89 (95.6%). UN provided adequate samples in 86 (93.4%) and VFMN in 66 (71%), a significant difference (P < 0.001). Among 43 patients diagnosed with active PTB, the diagnosis was confirmed in 39 with the samples obtained by sputum induction. Direct acid-fast bacilli smear was positive in 8 (19%). Direct costs were low and the technique can be performed on the day the patient attends the outpatient clinic. CONCLUSION: Sputum induction with an ultrasonic nebuliser was well-tolerated, of low cost, allows adequate samples to be obtained in the majority of patients who cannot produce sputum, and was more effective than the Venturi-type face mask.

Adolescent↗
PubMed1992

Endobronchial hamartoma. A case report.

A patient with a very rare benign bronchial tumour who presented in a most unusual manner is described. An endobrachial hamartoma was expectorated 24 hours after bronchoscopic manipulation for a suspected malignant tumour.

Bronchial Neoplasms↗
PubMedDate not supplied

Pleuro-biliary fistula--a delayed complication following open cholecystectomy.

A 24-year-old lady presented with bilious expectoration and history suggestive of obstructive jaundice, 16 months following open cholecystectomy. Pleurocentesis was done, followed by intercostal drainage, which drained about 300 mL bilious fluid per day for a month. Her symptoms of obstructive jaundice were relieved. A pleuro-biliary fistula was demonstrated by percutaneous transhepatic cholangiogram, HIDA scan and ERCP, which showed complete cut-off at the lower end. The patient underwent bilio-enteric bypass with gastric access loop, with complete healing of the pleuro-biliary fistula.

Adult↗
PubMed2000

[Chronic cor pulmonale: a study of 34 cases in the Dakar University Hospital Center Cardiology Department].

The authors report the results of a study on patients with chronic cor pulmonale hospitalized in the Departement of Cardiology (Dakar), from 1990 to 1998. The hospital prevalence is 0.9% with a male predominance (73.5%). The clinical signs were dominated by dyspnea and cough. The right heart failure is noted in 85.29% of cases. As far as the biological factor is concerned, it exists an polycythemia about 75% of cases, hypoxia (88.8%), hypercapnia (55.5%) and a respiratory acidoses (55.5%). The spirometry showed in 66% of cases, a mixed syndrom with obstructive predominance. The echocardiography showed in all cases right heart dilatation with pulmonary hypertension. The etiological factors are dominated by tobacco (21 cases). The hospital evolution has been favorable in 19 cases underoxygentherapy, lowdosediuretic, expectorant, bronchodilatators and salt restriction. However, 14 patients have died.

Academic Medical Centers↗
PubMed2005

[Saponins in nutrition of swine, poultry and ruminants].

Saponins are glycosides found in many plants, which have soap character due to their surfactant properties. They work haemolytic and may cause symptoms of intoxication in high concentration. Among therapeutically relevant effects expectorative, anti-inflammatory and immune-stimulating effects have the highest ranking. Beyond that, saponins demonstrate antimicrobial properties particularly against fungi and additionally against bacteria and protozoa. In animal nutrition additions of saponins can suppress intestinal and ruminal ammonia production. The ammonia-reducing effect is primarily attributed to an inhibition of proteolytic microorganisms. Due to reduced NH3-concentrations metabolism is relieved, which offers benefits to animal welfare and animal performance. Accordingly improved feed convertion ratio can be registered in weanling and growing-finishing pigs with the employment of saponin-containing feed additives. With regard to ruminal fermentation in vitro and in vivo studies have shown that beside proteolytic protozoa also cellolytic and amylolytic bacterial species are restrained. To what extent antimicrobial activity supress digestion or whether the selective effects on microorganisms can be used purposefully to manipulate ruminal fermentation, must be clarified in further investigations.

Animal Feed↗
PubMed2005

[A case of Kartagener's syndrome].

This case describes a 57-year-old woman in whom situs inversus had been noted at her birth. She had bronchial asthma and bilateral sinusitis during her childhood. She married and experienced childbirth. In December 2003, she was admitted to our Division complaining of wheezing, expectoration and dyspnea on effort. Bronciectasis was visualized on chest X-ray and CT. Electron microscopic examination of the nasal cavity epithelium and bronchial epithelial cilia revealed a deficit of bilateral dynein arms. These findings, helped establish a diagnosis of Kartagener's syndrome, which is characterized by primary ciliary dyskinesia. The restrictive and obstructive pulmonary dysfunction with increase of residual volume in the lung function tests and diffuse centrilobular small nodules with hyperinflation on chest CT were consistent with the findings of diffuse panbronchilitis (DPB) and suggested extended obliterative peripheral airway disease. Clarithromycin which is highly effective for DPB failed to prevent the aggravation of airway infection, arousing the concern about the progression into chronic respiratory failure.

Ciliary Motility Disorders↗
PubMedDate not supplied

[Tuberculosis and AIDS: various clinical and epidemiological aspects in 72 Cuban patients].

72 AIDS patients with tuberculosis diagnosis discharged from "Pedro Kouri" Tropical Medicine Institute between January, 1997, and March, 2001, were included in the research aimed at studying tuberculosis in HIV/AIDS patients. A descriptive and retrospective design was used and clinical, epidemiological and microbiological variables were described. The CD4 T lymphocytes count was also determined. Males prevailed (72.2% of the cases) with an average age of 30.83 years old and 4.82 average years between the HIV serodiagnosis and tuberculosis. In 48.6% of the cases, AIDS was defined due to tuberculosis. Cough, expectoration, fever of unknown origin, night sweating and weight loss were the most frequent symptoms. The mean CD4 count was 179 cells per mm3. 76.4% had less than 200 cells per mm3 (p < 0.05). Pulmonary tuberculosis was the form of presentation in 79.2% of the patients without association with the immunosuppresion degree. The chest X-ray showed alterations in 83.3% of the cases, the inflammatory infiltrate of the bases, and the mediastinal and pleural taking were the most representative. The positivity rate of baciloscopy was 45.8%, whereas the culture was positive in 62.4% of the patients (p < 0.05). The results of the previous tests were not significantly associated with the mean CD4 count. Anergy to tuberculin was reported in 50 patients (69.4%) (p < 0.05). The CD4 mean in the anergic patients (109 cells) was markedly lower than in the rest (403 cells) (p = 0.0009).

Acquired Immunodeficiency Syndrome↗
PubMed2005

Nitric oxide metabolites in induced sputum: a noninvasive marker of airway inflammation in asthma.

OBJECTIVE: This study was designed to examine for nitric oxide (NO) metabolites in induced sputum as a marker of airway inflammation in asthmatic children. DESIGN. Prospective interventional SETTING: Pediatric Allergy and Asthma Clinic of a tertiary care referral hospital in Northern India. SUBJECTS: Twenty-one children with asthma who were not receiving corticosteroids for the preceding 3 months and 10 healthy controls were enrolled. METHODS: Hypertonic saline-induced sputum was obtained at study entry in controls, and at study entry and after 6 weeks of inhaled corticosteroid (ICS) therapy in asthmatic children. Fresh expectorated sputum was treated with dithiothreitol and cytospinned for cell count. NO metabolites were measured in the supernatant by the modified Griess reaction. RESULTS: Asthmatic children, compared with controls, had significantly higher concentration of NO metabolites (22.4 +/- 209.69 vs 39.2 +/- 15.9 (moL/L, P <0.01) and a higher percentage of eosinophils (15.3 +/- 12.0 vs 0.8 +/- 1.1%, P <0.01) in induced sputum. Both NO metabolites and eosinophil percentage declined following treatment with ICS for 6 weeks (P <0.01). CONCLUSION: The study confirms that the level of NO metabolites is increased in the tracheobronchial secretions of asthmatic children and decreases following ICS therapy. Measurement of NO metabolites in induced sputum may be useful for monitoring airway inflammation in children with asthma.

Adolescent↗
PubMed2005

Postoperative bronchial stump fistula responding well to occlusion with metallic coils and fibrin glue via a tracheostomy: a case report.

An 80-year-old man underwent middle and lower lobectomy of the right lung to treat squamous cell carcinoma (SCC) (4 cm in diameter) originating from the right B4 bronchus. On the 4th postoperative day, a massive air leak from the thoracic drain was noted. At that time, a diagnosis of bronchial stump fistula was made on the basis of the bronchoscopic findings. Continuous thoracic drainage, aspiration of sputum via a tracheostomy and intravenous administration of antibiotics were performed immediately after the diagnosis. However, the patient's condition was complicated by aspiration pneumonia. On the 11th postoperative day, bronchoscopic procedure to close the bronchial fistula was performed via the tracheostomy. During this procedure, metallic coils were first inserted into the fistula to serve as the core for occlusion. Then, instead of directly infusing fibrin glue, several small beans-sized pieces of Surgicell cotton (Johnson & Johnson Co., Cincinnati, OH) soaked in fluid A (concentrated fibrinogen) and the same number of Surgicell cotton pieces soaked in fluid B (thrombin) were alternately inserted into the fistula, to allow closure of the bronchial fistula. After this procedure, the embolus created remained in place without being expectorated, and the aspiration pneumonia entered remission, allowing the patient to be discharged from the hospital on the 24th postoperative day. At preset, 14 months after surgery, the patient is in good condition. This technique allows simple and reliable closure of a fistula if a tracheostomy is available. It should be selected as a therapy of first choice when dealing with patients with a postoperative bronchial stump fistula in poor general condition. Patients undergoing right pneumonectomy or middle and lower lobectomy of the right lung should be considered as belonging to a high risk group for bronchial fistula and as requiring preventable measures (e.g., covering the stump with an intercostal muscle flap).

Aged↗