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PubMed2006

[Treatment of non-tuberculous pulmonary mycobacteriosis].

The non-tuberculous mycobacteriosis (NTM) is not a unitary disease. It is a general term for the bronchopulmonary diseases caused by any mycobacterium other than M. tuberculosis. We don't call the pulmonary "pseudomoniosis" for the diffuse bronchiectasis caused by Pseudomonas aeruginosa, though conditions of the disease looks like NTM. The name of NTM represents that the causativebacteria belong to the same species with M. tuberculosis which causes serious pulmonary infectious disease. The pulmonary diseases caused by M. kansasii or M. szulgai are usually treated by RFP, EB and INH, the same regimens with tuberculosis, which generally lead to sufficient results for patients. But for MAC diseases, the number of patients is top of NTM in Japan, recent treatment with new-macrolides and some anti-tuberculous drugs generally does not bring about the desired effect. The plenty clinical experiences for NTM in HIV positive patients have lead to such new regemens in the USA. For NTM caused by rare Mycobacterium detectedvery seldom, clinical experiences and knowledge are definitely insufficient. (1) Present state of therapy for pulmonary MAC disease (drug therapy): Yoshihiro KOBASHI (Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kurashiki, Okayama Prefecture) Co-operative study of Research Committee of Mycobacterium in the Chugoku and Shikoku areas revealed that the combined therapy according to the guidline is clinically appropriate for pulmonary Mycobacterium avium complex (MAC) disease. (2) Relapse and chemotherapy duration of pulmonary Mycobacterium avium complex infection: Atsuyuki KURASHIMA (Division of Clinical Research, National Organization Tokyo National Hospital, Kiyose, Tokyo) Reviewing the 71 relapses out of 1170 pulmonary MAC infection cases, he indicated that 11.3% relapsed during the chemotherapy continuation, 23.9% after the reduction of chemotherapy, 64.8% after the termination of chemotherapy. In the last group, there is no correlation to the relapse period after the end of treatment with the preceding chemotherapy duration. It is supposed that the main cause of these relapses are enviromental re-infection. (3) Chemotherapy for pulmonary M. kansasii disease: Katsuhiro SUZUKI (Clinical Research Center, Nationl Organization Kinki-chuo Chest Medical Center, Sakai, Osaka) Analysis of 938 pulmonary mycobacteriosis in 2003 revealed that 244 (26%) patients suffered from NTM, in which 66 (27% of NTM) were M. kansasii disease. The 48 (73%) patients were male. From 2001 to 2004, in the 190 M. kansasii patients treated by anti-tuberculous drugs, H/R/E prescribed for 84 cases (44%), other 41% of prescriptions included CAM and (or) LVFX. Almost all patients were converted into bacilli negative in about 30 days with any prescription. (4) Treatment and management for NTM patients in aprivate clinic: Seiji MIZUTANI (Mizutani Respiratory Clinic, Nerima ward, Tokyo) Analysing clinical experiences, he emphasized that most NTM patients with some symptoms visits private clinics in the first place. In Japan, diagnosis of NTM with radiological and bacteriological examinations is not difficult, and most NTM patients can be controlled as the outpatients of the clinics. (5) Surgical Treatment for non-tuberculous mycobacteriosis: Kouji KIKUCHI (Division of Chest Surgery, Medical Center, Saitama Medical School, Iruma county, Saitama Prefecture) The 9 NTM cases surgically treated were analysed, 8 were MAC cases and 1 was M. kansasii case. The main reasons for sugical resection were, continuous hemoptisis, continuous productive cough, or exacerbation on chest X-ray features. The NTM bacilli were positive in 8 cases, another one was bacilli negative, though X-ray shadows increased. After the surgery, expectoration of bacilli converted to negative in 5 SPECIAL COMMENTARIES: Can pneumonectomy be an acceptable procedure for non-tuberculous mycobacterial infection?: Yuji SHIRAISHI (Division of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo) The 11 NTM patients were analysed, who underewent pneumonectomy. The median blood loss was 555 ml and there was no operative mortality. Bronchpleural fistula or empyema occured in 4 patients. The bacilli negative conditions were achieved in all patients after surgery. The NTM is not a legal epidemic disease and Japanese Tuberculosis Prevention Act doesn't cover this disease. The medical treatment insurance system doesn't contain the NTM in the list of applicable diseases in Japan. Though these some problems with increasing numbers of patients remain in clinical practice, chairpersons hope that this symposium will be a milestone for the generalized progress of treatment and management of NTM in Japan.

Antitubercular Agents↗
PubMedDate not supplied

A multicentric study on epidemiology of chronic obstructive pulmonary disease and its relationship with tobacco smoking and environmental tobacco smoke exposure.

INTRODUCTION: Population prevalence of chronic obstructive pulmonary disease (COPD) and its relationship with tobacco smoking, environmental tobacco smoke (ETS) exposure and other variables were studied in adult subjects of 35 years and above at four different centres in India. Question-items for the diagnosis of COPD were included in the questionnaire used for the field study on asthma epidemiology. METHODS: Field surveys were conducted in both the urban and the rural populations at Bangalore, Chandigarh, Delhi and Kanpur with the help of a structured and validated questionnaire for diagnosis of asthma and COPD. Separate sets of questions were used for the diagnoses of the two diseases. A two-stage stratified sample design was employed where a village or an urban locality formed the first stage unit and a household formed the second stage unit. A uniform methodology was used at all the four centres and the analyses were done at the central coordinating centre--Chandigarh. Chronic obstructive pulmonary disease, defined by chronic bronchitis (CB) criteria, was diagnosed from the presence of cough and expectoration on most of the days for at least three months in a year for two consecutive years or more. RESULTS: Chronic obstructive pulmonary disease was diagnosed in 4.1% of 35295 subjects, with a male to female ratio of 1.56:1 and a smoker to nonsmoker ratio of 2.65: 1. Prevalence among bidi and cigarette smokers was 8.2% and 5.9%, respectively. Odds ratio (OR) for COPD was higher for men, elderly individuals, lower socio-economic status and urban (or mixed) residence. Environmental tobacco smoke exposure among nonsmokers had an OR of 1.4(95% CI 1.21-1.61). Combined exposure to both ETS and solid fuel combustion had higher OR than for ETS exposure alone. CONCLUSIONS: Population prevalence of COPD is very high in India with some centre to centre differences. Smoking of both bidis and cigarettes, and ETS exposure among nonsmokers, were two important risk factors at all centres. It is important to employ uniform methodology for assessment of national burden and disease-surveillance programme.

Adult↗
PubMed2005

Community respiratory viruses as a cause of lower respiratory tract infections following suppressive chemotherapy in cancer patients.

BACKGROUND AND PURPOSE: Community respiratory viruses are an important cause of respiratory disease in the immunocompromised patients with cancer. To evaluate the occurrence and clinical significance of respiratory virus infections in hospitalized cancer patients at National Cancer Institute, Cairo University, during anticancer treatment, we studied cases that developed episodes of lower respiratory tract infections (LRTI). PATIENTS AND METHODS: Thirty patients with LRTI were studied clinically, radiologically, and microbiologically. Sputum cultures were done and an immunofluorescence search for IgM antibodies of influenza A and B, parainfluenza serotypes 1, 2 and 3, adenovirus, respiratory syncytial virus, Legionella pneumophila, Coxiella burnettii, Chlamydia pneumoniae, and Mycoplasma pneumoniae were performed on serum samples of patients. RESULTS: The main presenting symptom was cough and expectoration. Hematologic malignancy was the underlying disease in 86.6% of cases. Blood cultures were positive in 11 patients (36.6%) only. Sputum cultures revealed a bacterial pathogen in 13 cases and fungi in 3; whereas viral and atypical bacterial IgM antibodies were detected in 13 and 4 patients; respectively. Influenza virus was the commonest virus detected, being of type B in 4 cases, type A in one case and mixed A and B in another 5 cases; followed by RSV in 5 patients. Taken together, bacteria were identified as a single cause of LRTI in 10 cases, viruses in 6, fungi in 3 and mixed causes in 7. Still, there were 4 undiagnosed cases. CONCLUSIONS: This study showed that respiratory viruses are common in LRTI, either as a single cause or mixed with bacterial pathogens, in hospitalized cancer patients receiving chemotherapy. Diagnostic tests for respiratory viruses should be incorporated in the routine diagnostic study of patients with hematologic malignancies. Also, it must be emphasized that early CT chest is crucial as a base-line prior to initiation of anti-fungal or anti-viral therapy. In cancer patients with a febrile episode and LRTI, tailored therapy is recommended according to the clinical findings of the patient.

Adolescent↗
PubMed2006

[A case of silicotuberculosis with difficulty in its diagnosis].

A 68-year-old man who had worked as a stone mason for more than 50 years with a heavy smoking history consulted our clinic with symptoms of cough, low grade fever, weightloss, malaise and a single expectoration of hemo-sputum. He had been diagnosed as silicosis by the mass survey 5 years ago based on nodular shadows with egg-shell calcification in hilar lymphnodes on his chest radiography, and has received chest radiographic examination once a year. As the author was not so familiar with the radiographic features of silicotuberculosis, it was difficult to interprete ill-defined contour of silicotic nodules accompanied by patchy opacities formation in right midlung field and silicotic conglomeration accompanied by an ischemic cavity in the left basal segments. A definitive diagnosis could not be established until 10 months later when a second attack of exacerbation of silicotuberculosis occurred showing multiple thin walled fresh tuberculous cavities on the chest radiography with positive smear and culture. Among multiple tuberculous cavities, there was a cirrhotic-walled cavity caused by endogenous reactivation of a quiescent tuberculous lesion on the right apex. This lesion was considered to be the source of dissemination of this case. Finally, it took about two and a half years before establishing the diagnosis in this case because of a series of doctors delays. He was treated successfully with antituberculous drugs for one and a half years including one year rifampicin medication. The clinico-pathological findings of silicotic conglomeration in the left basal segments were discussed based on the findings of transbronchial biopsy from occluded B10 and chest radiographic findings, and it was revealed that silicotic conglomeration might consist of inflammatory granulation combined with granulomatous tubercle, but not a fibrous lesion.

Aged↗
PubMedDate not supplied

Allergic bronchopulmonary aspergillosis.

A case of allergic bronchopulmonary aspergillosis (ABPA) is presented, followed by a discussion of the clinical characteristics, pathogenesis, diagnosis, and management of this disease. Special emphasis is given to clinical pearls and pitfalls for the practicing allergist. ABPA is a hypersensitivity response to Aspergillus antigens in the lung and is distinct from other forms of Aspergillus pulmonary disease. Episodic bronchospasm, expectoration of mucous plugs, and fleeting pulmonary infiltrates are common manifestations of the disease. Several diagnostic schemes for ABPA have been described with varying criteria, which uniformly includes asthma and positive immediate skin-prick test to Aspergillus fumigatus. The mainstay of treatment for ABPA is corticosteroids, which are normally effective.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed2006

[Abdominal pain, indigestion and eosinophilia].

A 56 years old swiss man suffers of recurrent abdominal cramps with episodes of diarrhea and profuse expectorations. The routine laboratory shows principally a massive eosinophilia and elevated IgE in peripheral blood. After excluding the most frequent causes of eosinophilia, further laboratory investigations shows increased levels antinuclear and anti-SSA antibodies, elevated IgG4, increased pancreatic amylase and intestinal eosinophilia. We consider two etiologies: the hypereosinophilic syndrome, diagnostic of exclusion, and the autoimmune pancreatitis. Although we have not sufficient arguments in favour of an autoimmune pancreatitis, these two entities present some similar points.

Abdominal Pain↗
PubMedDate not supplied

[Disseminated infections due to Scedosporium apiospermum in a patient with anaplastic large cell lymphoma. A case study].

A 42-year-old man was diagnosed with hepatosplenic T-cell lymphoma in November 2003. Remission was incompletely achieved despite 10 courses of chemotherapy. He developed fever (38.5-39 degrees C), chills, cough and morning expectoration after the 61 courses of chemotherapy. During this period, an ultrasound of the abdomen showed multiple hypodense lesions of the liver. Culture of the sputum yielded Scedosporium apiospermum. Fungal cultures from blood remained negative. The patient was treated with voriconazol. After one month from therapy, an ultrasound examination showed decreasing of hypodense lesions of the liver, and no further lesions appeared. Based on significant improvement of liver lesions with voriconazole therapy, we proposed the diagnostic "probable" disseminated infections due to S.apiospermum.

Adult↗
PubMed2006

[COPD--how to deal with an acute exacerbation].

Exacerbations in COPD patients are characterized by an acute aggravation of the condition with an increase in symptoms (labored breathing, cough, expectoration, tightness of the chest and, rarely, fever). The major cause is a bronchial infection. The medications of choice are inhalative bronchodilators, in particular beta-2 sympathomimetics and/or anticholinergic agents, together with systemic glucocorticosteroids, and also theophylline. COPD patients experiencing exacerbations and showing clinical signs of bacterial airway infection can benefit from antibiotic treatment. In the presence of an acute partial respiratory insufficiency, administration of oxygen is indicated, while respiratory insufficiency with hypercapnea and acidosis necessitates the use of noninvasive positive pressure ventilation. For the prevention of acute exacerbations, risk factors must be eliminated, in particular cigarette smoking. Furthermore, optimized management including structured patient education is to be recommended.

Acute Disease↗
PubMed2006

[Primary tracheobronchial amyloidosis].

The primary tracheo-bronchial amyloidosis is a rare entity with long lasting and progressive course. Precise diagnosis can be established on the basis of pathological features seen in samples derived from the airways, obtained during fibreoptic bronchoscopy or during lung biopsy sometimes. Describing the case of an insidious course of primary tracheobronchial AL type amyloidoisis, that was initially recognised and treated as a chronic obstructive pulmonary disease. The authors represent its clinical course and the diagnostic difficulties. The changes in the respiratory tract, both radiological and endoscopic suggested a tuberculous or proliferative process. They were responsible for a severe increasing dyspnoea, due to bronchial obstruction, with muco-haemoptic expectoration. A forceps resection of the endobronchial lesions enabled to established the right diagnosis and further treatment limited to local procedures.

Amyloidosis↗
PubMed2006

The composition of unstimulated whole saliva of healthy dental students.

The purpose of this study was to determine the unstimulated whole saliva biochemical parameters in healthy dental students of Tehran University of Medical Sciences (TUMS) living in the students' dormitory with a mean age of 22 years. Five ml whole saliva samples were obtained by expectoration. The saliva composition was measured by a spectrophotometer and affiliated kits. The data was analyzed through the student's unpaired t-test using the SPSS program. In the male students (n=50) the mean concentrations of glucose (mmol/l), inorganic phosphate (mmol/l), total protein (mg/ml), magnesium (mmol/l), chloride (mmol/l), and calcium (mmol/l) were 0.75+/-0.44, 1.52+/-0.63, 6.69+/-2.89, 1.27+/-0.45, 27.60+/-11.06, and 2.17+/-0.76, respectively. In the female students (n=50) they were 0.73+/-0.47, 1.58+/-0.63, 7.26+/-3.78, 1.37+/-0.44, 30.42+/-12.74, and 1.87+/-0.78, respectively. There were no significant differences between the whole saliva values in male and female students.

Adult↗
PubMedDate not supplied

[Value of ambroxol in treatment of bronchial asthma and spastic bronchitis].

Ambroxol (Bronchopront-Mack) was administered to 73 patients with the bronchial asthma and spastic bronchitis with expectoration disorders. The drug was given in the dosage forms of slow release capsules, syrup, drops, intramuscular injections and inhalations for about 14 days. All patients have been carefully examined clinically, PEF has been measured, and sputum physico-chemical properties have been tested prior to and 10 days after treatment. Complete disappearance of cough, liquefaction of sputum and clearance of airways have been achieved in 47% of patients. A significant improvement has been noted in 38.4% of cases. The treatment failed in 2.7% of patients. Ambroxol has been well tolerated. No adverse effects on laboratory findings have been noted. Results suggest, that ambroxol is valuable drug in the combined treatment of patients with the bronchial asthma and spastic bronchitis.

Adult↗
PubMedDate not supplied

Idiopathic endogenous lipoid pneumonia.

Lipoid pneumonia is a rare pulmonary disorder having no classical radiological appearance. We report a 33-year-old male, ex-smoker who was referred to us with history of cough, mild mucoid expectoration and progressively increasing dyspnoea since one year. He was investigated at local hospital and was treated with 30 mg prednisolone per day for 6 months for sarcoidosis without any response. On examination, he was normal except for fine basal crepitations in chest. Pulmonary function test (PFT) revealed mild airway obstruction. High resolution computerised tomographic scan (HRCT scan) revealed bilateral reticulonodular shadows and bronchiectasis in lower zones. Open lung biopsy revealed lipoid pneumonia. As there was no history of nasal distillation of oils, it was diagnosed to be idiopathic. The relevant literature is reviewed.

Adult↗
PubMed1991

[Pneumocystis carinii pneumonia in HIV infection. Diagnosis, prognostic factors and curative treatment].

The diagnosis of Pneumocystis carinii pneumonia (PCP) rests on the isolation of this micro-organism in patients whose latest blood count, less than 2 months old, shows less than 250 CD4 lymphocytes per cubic mm and who present with signs of impaired lung function. Bronchoalveolar lavage (BAL) is the reference diagnostic method, but induced expectoration may be the initial examination, in which case BAL is performed only when the latter fails or gives negative results. Prognostic factors are those of any interstitial pneumonia plus those specific to PCP and those associated with HIV infection. It is only when no initial severity factor is present that cure can be contemplated, provided the effectiveness of treatment is evaluated daily. Cotrimoxazole is the reference drug for comparisons with all new treatments; the indications of corticosteroid therapy and the necessity of intensive care techniques are now better determined. The frequency of PCP and its mortality rate should be reduced, and one may look forward to a time when this disease will be rare and atypical, thereby raising other diagnostic and therapeutic problems.

Adrenal Cortex Hormones↗
PubMed2006

[Perioperative management for primary tracheal malignant tumors resected under cardiopulmonary bypass].

OBJECTIVE: To retrospectively review the perioperative management for primary tracheal malignant tumors resected under cardiopulmonary bypass. METHODS: The data of 6 patients with primary tracheal malignant tumors who underwent surgery under cardiopulmonary bypass from December 1999 to August 2003 were reviewed. Cardiopulmonary bypass was established through right femoral vessels in 2 patients for emergency operation, through right atrium and ascending aorta in 4 patients. Sleeve tracheal resections in 3 patients, carinal resections and carina reconstructions in 2, and local enucleation in 1 were performed. Respiratory airway was kept patent by coughing and expectorating sputum. RESULTS: All patients' dyspnea were relieved remarkably. The postoperative mechanic ventilation assistance lasted from 10 hours to 7 days. There was no perioperative mortality. CONCLUSION: Resection of primary tracheal malignant tumors with severe tracheal obstruction under cardiopulmonary bypass is practicable. Keeping respiratory airway patent perioperatively is very important and helpful to postoperative recovery.

Adult↗
PubMed2005

Respiratory tract infection due to Arcanobacterium haemolyticum--a case report.

A case of respiratory tract infection due to Arcanobacterium haemolyticum is reported. A female of 26 years presented with cough with expectoration and fever off and on for a duration of six weeks. Mycobacterium tuberculosis and Arcanobacterium haemolyticum were isolated. Arcanobacterium haemolyticum was isolated on three separate occasions.

Actinomycetaceae↗
PubMed2006

[Characteristics of airway involvement in relapsing polychondritis].

OBJECTIVE: To investigate the characteristics of airway involvement in relapsing polychondritis (RP). METHODS: The clinical data, including clinical manifestations, respiratory function test, computerized tomography (CT), and bronchoscopy of 38 out of the 56 RP patients who had airway involvement, 20 males and 18 females, with the mean onset age of 45 +/- 11 (27 - 71), and 3 RP patients without airway involvement were retrospectively analyzed. Three patients out of the 16 RP patients who did not have respiratory involvement but underwent respiratory function test, CT, and bronchoscopy were used as controls. RESULTS: The symptoms of airway involvement included cough, expectoration, hoarseness, feeling of suffocation, asthma, and dyspnea. Obstructive disturbance of ventilation was found in 10 and mixed disturbance of ventilation was seen in 2 of the 18 RP patients with airway involvement. The forced expiratory volume in one second, ratio of forced expiratory volume in one second to forced vital capacity, peak expiratory flow, FEF50/FIF50, and maximal mild-expiratory flow of the patients with airway involvement were 1.4 L +/- 0.23 L, 46.0 +/- 4.86, 3.3 L/s +/- 0.67 L/s, 0.3 +/- 0.08, and 0.4 L/s +/- 0.18 L/s respectively, all significantly lower than those of the RP patients without airway involvement (2.5 L +/- 0.09 L, 83.7 +/- 2.24, 6.9 L/s +/- 0.52 L/s, 1.3 +/- 0.51, and 2.8 L/s +/- 0.73 L/s, all P = 0.01). Flow volume loop showed remarkable decrease of PEF and formation of a plateau in the expiratory phase in the RP patients with airway involvement. CT performed in 27 RP patients with airway involvement showed trachea stenosis in 11, and thickened airway wall in 8 of them. Bronchoscopy performed in 23 patients with airway involvement showed inflammation in 16, destruction of tracheobronchial cartilage in 6, collapsed tracheobronchial wall in 7, tracheal stenosis in 15, left major bronchial stenosis in 13, and right major bronchial stenosis in 12 of them. CONCLUSION: Respiratory function test is sensitive in early detection of airway involvement in RP. Bronchoscopy and CT are useful in evaluation of the severity of airway involvement in patients with RP.

Adult↗
PubMed2006

Resonance of sputum spigot with air vibration.

A mathematical model calculation has been presented on the resonant frequency of the oscillating sputum spigot in a cylindrical pipe, with which we investigated similar phenomena in bronchial tubes. We confirmed the theoretical results by two types of experiments using pseudo-sputum (5 and 10% solutions of mucin) spigots instead of a human pulmonary one, and found the model was suitable for estimating the effects of clinical vibrational treatments expectorating sputum spigots plugged in small bronchi. The main points of the paper are summarized as follows. 1. The validity of the fluid model used was verified using reported experimental data of Litt and co-workers. After adjusting their data in a Casson plot, Casson fluidity was found to be the best parameter to represent viscosity of the sputum. 2. A theoretical investigation on the vibrational sputum spigots in narrow tubes was done using an analytical model calculation. From the resultant formula, which expresses the resonant frequency of the oscillation of the spigot with its physical values (the radius of the airway, the length of the spigot, the elasticity of the sputum, and the surface tension), many points became clear; for example, the resonant frequency of sputum spigot vibration in a narrow bronchial tube is too high to propagate there under the effective influence of surface tension. 3. Two experiments were performed with pseudo-sputum (5 and 10% solutions of mucin) instead of a human pulmonary one. After substituting the resonant frequencies of the pseudo-sputum spigot vibration in our tube experiment into the resultant formula derived from our analytical model calculation we estimated the elasticity values, which agreed with those from our plate experiment. The validity of our theory was strongly supported by this agreement.

Elasticity↗
PubMed2006

[Use of transport medium in sputum bacterial culture examination of lower airway infection].

Our medical institution does not have a bacterial culture facility, requiring outsourcing of bacterial culture tests. Due to the time elapsed from the time of specimen collection to culturing, the identification of causative bacteria in respiratory tract infections tends to be difficult. We therefore used transport medium for sputum bacteria examinations. Expectorated purulent or purulent-mucous sputum specimens were collected from 32 patients with lower respiratory tract infection. We divided each of the sputum specimens into the two treatment groups: transport medium (Seedswab gamma2) ndar and stad disinfection container. Paired samples prepared from each patient were sent out for bacterial culture together. The time elapsed from collection to delivery to the lab were as follows: day 0 (same day, n = 14 patients), day 1 (n = 15), day 2 (n = 2), and day 3 (n = 1). The identified causative bacteria were Streptococcus pneumoniae (n = 6 patients), Haemophilus influenzae (n =5), Pseudomonas aeruginosa (n = 4), Staphylococcus aureus (n = 2), Moraxella catarrhalis (n = 2), Klebsiella pneumoniae (n = 1), and Streptococcus agalactiae (n = 1). Samples prepared by each of the two methods gave similar results. The utility of transport medium for examination of general bacteria for lower airway infection from sputum samples was not demonstrated. The rate of detection of bacteria decreased, when the transport of samples was delayed. Therefore, we need to send the sputum specimens as quickly as possible.

Adult↗