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PubMed1991

[Experimental replacement of the trachea by dacron-silicone rubber prosthesis].

Experimental results of trachea replacement by dacron-silicone rubber tube in rabbits and dogs were presented. The techniques for anastomosis of the prosthesis to the host trachea, prevention of obstruction by granulation and the dynamic effects of air current during cough reflex caused by the artificial trachea were also investigated. Experiments showed that the use of artificial trachea with right size (inner diameter) was the key to maintain expectoration mechanism. When the artificial trachea was constructed on proper selected cases, complications resulting from use of Nevilles are preventable.

Anastomosis, Surgical↗
PubMed1991

[Comparison of nasal mucociliary clearance before and after operation in chronic sinusitis].

Nasal mucociliary clearance is a first line of defence mechanism of the respiratory system against inhaled particles. It transports particles depositing into the nasal passages to the pharynx to be swallowed or expectorated, thus protecting the respiratory system from injury. Clearance function is affected by many factors such as the chronic inflammation of the paranasal sinuses. A group of 13 healthy volunteers (controls) and a group of 17 patients suffering from chronic sinusitis was investigated in the Department of Otolaryngology of Taichung Veterans General Hospital between June and October of 1990. A radioisotope method was used to measure the velocity of nasal mucociliary transport in the participants. This involved the use of radioisotope Tc99m combined with albumin particles and measurements were made in one nasal chamber at a time. The sinusitis patients were then surgically treated and they all improved. In all 25 tests were made in the control group and the mean velocity of their mucociliary transport was found to be 4.56mm/min. In the patients 28 measurements were made and their mean velocity was found to be 2. 67mm/min before the operation and 4.03mm/min after the operation. The difference between pre- and post-operative velocities was statistically significant as was the difference between the pre-operative velocities of the patients and those of the controls. The difference between controls and patients after the operation was not significant.

Adolescent↗
PubMedDate not supplied

[Comparative serum and secretory IgA studies in recurrent bronchial infections (preliminary note)].

In a group of 84 patients with recidivating bronchial infections IgA were evaluated with the aid of radial immunodiffusion according to Mancini. In all the patients IgA were determined from expectoration extractions and in 50 of them serum IgA were also determined. In 38 cases the determinations were simultaneous. Concentration of S IgA was low in most of the cases (65%). These results are probably influenced by the technical difficulties raised by detaching the connections existing between S IgA and mucus fibrils from the bronchial secretion. The results obtained in the dosage of serum IgA are comparable with those mentioned in the current literature. No correlations were possible between S IgA and serum IgA and there proteins can be considered as independent.

Adult↗
PubMed1991

[Pneumocystis carinii pneumonia in patients with AIDS in the Congo].

Forty-five bronchoalveolar lavages (BAL) were performed in Brazzaville in AIDS patients who did not expectorate acid- and alcohol-resistant bacilli (AARB). All patients presented with respiratory symptoms (cough, dyspnoea or chest pain), and all but 6 of them had abnormal radiography of the chest. Four cases of pneumocystosis were diagnosed (9%); 3 of these patients had interstitial pneumonia and dyspnoea. No AARB was found at microscopic examination of BAL which showed Pneumocyctis carinii; no culture on Löwehstein's medium could be made. The authors consider that the low prevalence of pneumocystosis in Africa, compared with industrial countries, is due to a smaller dissemination of the parasite in Africa rather than to immunodepression which is known to be more pronounced in AIDS patients from industrial countries.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[A case of exogenous lipoid pneumonia showing a coin lesion with cavities].

A 26-year-old male was referred to our department because of an abnormal chest X-ray, obtained during a routine physical examination in the hospital admitted after a traffic accident. The P-A chest film revealed a coin lesion with cavities in the left S9. He complained of no symptoms except for expectoration of bloody sputum. Transbronchial lung biopsy specimens showed destruction of normal alveolar pattern and collections of lipid-laden macrophages enclosed by fibrous tissue. The lipid material of macrophages in sputum was stained with Sudan III. He had no difficulty in swallowing and no history of regular use of oily drugs. Fiberoptic bronchoscopy and chest CT showed no obstruction of bronchi. He had been working in a repair shop for motorcycles for years, therefore the lesion could be an occupational exogenous lipoid pneumonia. The diameter of the coin lesion has decreased without any therapy.

Adult↗
PubMed1991

[Lymphomatoid granulomatosis. A report of 2 cases].

Two patients with lymphomatoid granulomatosis were diagnosed by postmortem autopsy or exploratory thoracotomy. The lung, skin, spleen, renal and lymph nodes were involved. The most common presenting complaints are fever, cough, expectoration shortness of breath. The radiographic manifestations are multiple, bilateral nodular shadows. The histologic features is a unique form of pulmonary angiitis and granulomatosis, which is a necrotizing angiocentric and angio-destructive infiltrative process composed of small lymphocytes and atypical lymphoreticular cells.

Adult↗
PubMed1991

[Non-Hodgkin's lymphoma disclosed by an intrabronchial tumor. Apropos of a case].

Non Hodgkin's lymphoma (LNH) presenting as a localised tumour is exceptional and nearly always appears during the course of disseminated disease. We report a case where the primary disease was an endobronchial tumour and the entire clinical picture related to pulmonary symptoms. A 70 year old lady was found to have a left sided pulmonary opacity following a cough with minimal expectoration and accompanied by chest pains and dyspnoea. The chest abnormality progressed for 3 years 9 months before an endobronchial tumour was discovered at bronchoscopy in the left upper lobe and from which a biopsy revealed an LNH with small cells of low degree of malignancy. In addition there was splenomegaly and an infiltration of bone marrow by the lymphomatous process which was evidence of a disseminated form of LNH. To our knowledge our observation is an extremely rare case where an endobronchial tumour revealed a non Hodgkins lymphoma.

Aged↗
PubMed1977

[The clinical entity of primary tracheal cylindroma (author's transl)].

On the grounds of 5 own observations of primary tracheal cylindroma and under consideration of the cases mentioned in literature on this subject, the repeatingly occurring and, therefore, probably typical characteristics of this kind of tumour were described. In the course of the disease, three phases may quite easily be differentiated, and the special features of the main symptoms (dyspnoea, cough, expectoration, hoarseness) as well as apparently specific, however inconstant changes in the blood picture were set forth.

Adult↗
PubMed1991

[Long-term treatment of chronic bronchitis with pulmonary physiotherapy with and without positive expiratory pressure].

In a prospective, randomized, controlled study, treatment of chronic bronchitis with self-administered chest physiotherapy alone (control) or with positive expiratory pressure (PEP) by mask was studied. Forty-three patients completed the study (n = 20 PEP, and n = 23 control). After instruction, the treatments were self-administered twice daily for 12 months (34 patients) and five months (9 patients). The patients completed a diary concerning symptoms twice weekly. An acute exacerbation (AE) was defined as the appearance of mucopurulent or purulent sputum and increasing cough and one or more of the following symptoms: temperature greater than or equal to 38 degrees C, general malaise, increased dyspnea, increased mucus production, increased thickness of mucus or increased difficulty in expectoration. The number of AE were calculated from the diaries. The incidence of AE was significantly lower in the PEP group (p less than 0.0005). In the PEP group, three patients had a total of six AE, compared to 12 patients with 28 AE in the control group. The PEP group also used less antibiotics (p less than 0.005). Treatment with a simple PEP device can reduce morbidity in patients with chronic bronchitis.

Adult↗
PubMed1991

[An experimental study of chemical debridement of full-thickness burn in rabbits by N-acetylcysteine].

N-acetylcysteine, a mucolytic expectorant, was used for debridement of a full-thickness burn in rabbits. The drug was applied 24h postburn and repeated once a day. Debridement was completed in an average of 2.25 days with bloodless separation of any remaining eschar from the underlying healthy deep fascia layer by blunt dissection with a forceps. In the wounds treated with 25% N-acetylcysteine(pH 2.5), debridement was faster than those treated with glacial acetic acid mixture at the same pH. The debriding action of the drug is probably depolymerization of heat-denatured extracellular proteins (mainly denatured collagen and proteoglycans), disrupting specific linkage and lowering the molecular weight of eschar molecules. Acidity of the drug also promotes debriding process.

Animals↗
PubMed1991

[Improving drug prescription in primary care: a controlled and randomized study of an educational method].

BACKGROUND: The aim of the present study was to assess whether educational intervention on the primary care physician may be an effective method to improve drug prescription. METHODS: An experimental randomized controlled study was carried out in 244 physicians of the management area No. 5 of the Institut Català de la Salut. Intervention consisted in 3 individualized interviews with the 123 physicians of the study group (IG), during which written informative material was also presented. The issues were: cerebral and peripheral vasodilators (CPVD) and antibiotics. The changes in the prescription of CPVD, combination of anti-infective agents with expectorants, mucolytics and/or balsamics (R05C1) and cephalosporins were specially evaluated in both groups. Subsequently, a stratified analysis was carried out depending on the volume of prescription of the physicians. RESULTS: The IG showed a greater reduction in the prescription of CPVD (9.78 bottles per physicians and months versus 6.43, p less than 0.01). The relative reduction in R05C1 prescription was also higher in the IG (12.3% versus 6.7%, p less than 0.01). The expenditure showed similar results. The use of oral cephalosporins increased in the IG and was reduced in the CG (p less than 0.01). CONCLUSIONS: The results show a favorable impact of personalized information in the groups with high prescription volume, which is particularly remarkable in the highest prescribers.

Drug Prescriptions↗
PubMed1991

Diagnosis and management of pneumonia.

The management of patients with pneumonia, the fifth leading cause of death in the United States, remains frequently problematical. Because a precise etiologic diagnosis is often not possible when the patient is first examined, initial antibiotic therapy is often empiric. Problems in early diagnosis include the frequent lack of access to true respiratory secretions, necessary delays in identification of organisms in culture, and contamination of expectorated sputum with oropharyngeal bacteria. Early management must therefore depend on epidemiologic and clinical clues as well as examination of available respiratory secretions. It is generally helpful in the selection of initial antibiotic therapy to consider the disease in two broad epidemiologic categories, community- and nosocomially acquired. As new laboratory and clinical information become available, the appropriateness of the antibiotic therapy must be continually reevaluated.

Anti-Bacterial Agents↗
PubMed1991

[Therapy of the lower respiratory tract infections in aged patients. Clinical experience with ceftriaxone using a single daily dose].

Sixty-seven elderly patients affected by acute or chronic pulmonary pathologies were treated parenterally with ceftriaxone in a single dose of 2 g/day. A deterioration of the bacterial analysis of expectorate during or at the end of therapy was observed in 92.5% of patients; a reduced bacteria count was found in one case; and no clinical or bacterial effects were observed in 3 cases. No adverse effects or changes in the main hematochemical parameters were reported.

Age Factors↗
PubMed1990

[Mediastinal tuberculous adenopathies in Djibouti. Report of 159 cases].

One hundred and fifty-nine cases of confirmed mediastinal tuberculous adenopathy were analysed retrospectively. This series, which is the first reported in French-speaking Africa, shows that the disease is not uncommon there, and not restricted to black Africans living in Europe. The clinical symptoms are not specific. Radiography is more interesting, and the extreme scarcity of bacillys-containing expectoration encourages endoscopy. The finding of a fistula at fibroscopy confirms the diagnosis. This easy examination is particularly useful since M. tuberculosis can be grown in cultures from ground bronchial fistula biopsies in 86% of the cases. Associated tuberculous lesions in other sites are very frequent (45%), as is extension of the disease from lymph nodes to lung tissue (79%). This clinical form of tuberculosis can be treated with modern short course chemotherapy which is remarkably effective.

Adolescent↗
PubMed1990

[Diterpenoid constituents in bulbs of Fritillaria anhuiensis S.C. Chen et S.F. Yin].

The bulb of Fritillaria anhuiensis, a substitute for the traditional Chinese medicine Beimu, has been used as antibechic and expectorant. From the either soluble part of the bulb, four constituents were isolated and identified by spectral analysis (IR, MS, 1HNMR, 13CNMR) as beta-sitosterol, daucosterol, ent-kaur-15-en-17-ol and ent-kauran-16 beta, 17-diol.

Diterpenes↗
PubMed1990

[Management of respiratory infection after open heart surgery].

The results of a retrospective study on the management of respiratory infection after open heart surgery in 370 consecutive cases are presented in this paper. The incidence of postoperative respiratory infection was 3.8% (14 cases). There was atelectasis of the lung in 3, pneumonia in 6 and acute suppurative bronchitis in 5 cases. Among the 6 patients with postoperative pneumonia, one died of sepsis and another died of consolidation of the lung. The remaining 12 attained uneventful recovery after reasonable treatment with antibiotics, expectorant, oxygen therapy, inhalation therapy, bronchial lavage and aspiration. The prevention measures of postoperative respiratory infection are also discussed.

Adolescent↗
PubMed1990

[The physiologic disposition and pharmacokinetics of guaiacol acetylsalicylate in rats].

Guaiacol acetylsalicylate (GASL) has been shown to possess significant anti-inflammatory, antipyretic and expectorant activities and has been used clinically in chronic bronchitis with fairly good results. In the present work, the absorption, distribution and excretion of metabolites of the drug were studied in rats using quantitative TLC scanning technique. GASL was shown to be unstable in rat gastrointestinal tract and guaiacol salicylate (GSLT) and salicylic acid (SLA) were found in plasma. The plasma SLA concentration-time curve obtained after oral administration of GASL to rats was shown to fit a one compartment open model with the following pharmacokinetic parameters: T1/2ka = 1.25 h, T1/2ke = 3.28 h, ka = 0.5554/h, ke = 0.2111/h, Tmax = 3.02 h, Cmax = 331.46 micrograms/ml, AUC = 2832.93 micrograms/ml.h The SLA concentration was found to be high in muscle, moderate in spleen, testicle, kidney, lung, plasma, heart and liver and low in brain. The GSLT concentration was found to be low in plasma and organs. Within 24 h following ig administration of GASL the total SLA excreted in urine and feces was 10.9 and 0.41 of the GASL dose, respectively.

Animals↗
PubMed1990

[The participation of epithelial desquamation in the increase of bronchial hyperresponsiveness after antigen challenge in patients with bronchial asthma].

Bronchial hyperresponsiveness (BHR) was evaluated before and after antigen challenge in 12 patients with bronchial asthma as allergic reaction to house dust mites. Six out of the 12 showed an increase in BHR 48 hours after antigen challenge. Although there was no difference in the decrease of FEV1.0 in IAR and LAR between patients with (group A) and without (group B) the increase of BHR after antigen challenge, patients in group A expectorated a significantly larger number of clumps of respiratory epithelial cells (Creola bodies, CrB) in their sputum in both IAR and LAR. In addition, the degree of the increase of BHR significantly correlated with the CrB score, which was determined from the number and the size of CrB. These results suggest that epithelial desquamation participates in the increase of BHR after antigen challenge. The concentration of the eosinophil cationic protein (ECP) in their sputum did not change significantly in IAR and LAR compared with that before antigen challenge. There was no difference in the concentration of ECP in their sputum between the two groups either. One antigen challenge seemed to be too mild to induce an elevation of the concentration of ECP in their sputum. Judging from the fact that CrB could be observed not only at LAR but also IAR, epithelial desquamation seemed to be dependent on the degree of damage before antigen challenge rather than on the activation of eosinophils after antigen challenge.

Adult↗