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PubMed1989

[Comparative study of 2 classical technics of coloration and an indirect immunofluorescent assay applied to research on Pneumocystis carinii in the bronchoalveolar lavage fluid and induced sputum in HIV+ patients].

Two histochemical staining methods, eosine-methylene blue fast (RAL 555) and silver methenamine (modified Grocott's technique), and indirect immunofluorescence assay with an anticyst monoclonal antibody were used to detect Pneumocystis carinii in the broncho-alveolar lavage fluid and induced sputum from 58 HIV+ patients. Immunofluorescence disclosed the largest number of carriers (35 p. cent of examined patients). However, the histochemical staining techniques remain of interest and are the initial method of choice. They are inexpansive and rapid to achieve; less sensitive than immunofluorescence, positive results argue a high enough level of parasitism which leads to clinical manifestations. The increased sensitivity of immunofluorescence has considerably improved the ability to detect Pneumocystis in induced sputum. It allowed us to disclose 18 out 20 carriers (90 p. cent). However when a Pneumocystis is suspected, it is preferable to sample bronchoalveolar lavage fluid. Its examination is quick, easy and quantitative appreciation of results bring important diagnostic arguments. Other parasites, such as toxoplasmas, may also be detected. On the other hand, the examination of expectoration is time consuming and difficult to read and interpret. Therefore, sputum induction for the diagnosis of Pneumocystosis should be reserved to unequiped centers or insufficiently equiped centers (i.e., devoid of intensive care units).

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Catheter epidural analgesia in serial rib fractures].

According to our results, permanent epidural anaesthesia was significantly superior to systemic opioid treatment in patients with serial rib fractures. The main advantages were not only continuous pain relief despite the fact that the nonepidural control group required more than twice the dosage of morphine derivatives; also, the respiratory and pain-related recovery time was reduced. Another advantage was the selective effect (due to the local application) on respiratory pain and therefore on respiration as a whole. Deep breathing and expectoration were easier, so that the use of respirators and other artificial breathing aids could be avoided or at least reduced in duration in some cases. This makes the method particularly suitable for use in the management of polytraumatized patients. The standard dose was a mixture of 3.3 mg morphine and 37.5 mg bupivacaine (= 1/3 ampoule morphine + 15 ml Carbostesin 0.25%) every 12 h. When morphine was temporary contraindicated (frequently the final diagnosis in the case of an "acute abdomen" delayed the administration of morphine) the use of bupivacaine alone provided a satisfactory result for a certain time (we never observed tachyphylaxis). Additional systemic pain relievers were only necessary when the patient was suffering from pain caused by other injuries beyond the area of effectiveness of the epidural catheter (the only obvious disadvantage of the local application technique). On the other hand, epidural anaesthesia enabled us to treat a patient's lower-leg fracture by interlocking nailing, while adding only 0.01 mg fentanyl (= 2 ml Fentanyl Janssen) and 1.2 mg flunitrazepam (Rohypnol).

Adult↗
PubMed1989

[A retrospective study of 115 cases of fungal pneumonia].

115 cases of immunocompromised patients complicated with fungal pneumonia treated during the period from April 1968 to December 1986 were retrospectively studied. 96 were male and 19 female. Their age ranged from 6 to 84. The incidence increased significantly in recent years especially after 1983. Severe liver disease was the underlying disease in 102 (88.7%) patients. 108 (93.9%) had received antibiotics and 55 (47.9%) corticosteroids. Fungi species isolated were candida in 107 (54.9%), aspergillus in 82 (36.9%), penicillium in 7 (3.6%), mucormycetes in 6 (3%) and reotrichum in 3 (1.5%). Fever, cough, expectoration, moist rales diminished breath sounds and increase of W. B. C. and neutrophils were the important clinical features. The roentgenologic findings vary with the nature and extent of the pathologic process. Disseminated mycoses were found in 9 of the 18 autopsied cases. The characteristic pathologic findings were inflammation, abscess formation, vasculitis, infarction and hemorrhage. Extrapulmonary features such as enteritis, purulent nephritis, abnormal EKG, encephalopathy and rash were present. 93 cases received antifungal therapy including garlicin, clotrimazole, amphotericin B, nystatine, miconazole, 5-fluctosine and ketoconazole. Because these drug combinations were so complex, it is difficult to evaluate their efficiency. However the survival rate was somewhat elevated in recent years. The mortality rate of this series was 80.9%.

Adolescent↗
PubMed1989

Identification of subpopulations of bronchitic patients for suitable therapy by a dynamic rheological test.

The rheological properties of bronchial mucus samples, collected from randomly selected patients with chronic bronchitis by protected expectoration, under steady-state conditions without any exacerbation, were investigated in a double-blind multicentre study before and after five days of treatment with 4.5 g/day carbocysteine or with glucose as a placebo. Viscous and elastic properties of the mucus were measured with a rheometer fitted with coaxial cylinders set up in an oscillating instead of a rotating mode. The shapes of the ellipses obtained characterized the rheological properties of each bronchial mucus sample before and after treatment. Two different rheological patterns were observed. In the group of patients with initial viscosity greater than or equal to 10,000 mPa.s-1, carbocysteine treatment reduced viscosity and elasticity more than those of the placebo-treated patients. In the group of patients with viscosity lower than 10,000 mPa.s-1, the rheological modifications were the same for both groups. These results are discussed in terms of both the efficacy of carbocysteine and the necessity of rheological characterization of the patients before treatment into different groups, according to the rheological properties of their secretions, for better and targetted therapy with mucus modifying drugs.

Adult↗
PubMed1989

[Levels of alpha 1-antitrypsin in the blood of patients with chronic bronchitis].

Serum levels of alpha 1-antitrypsin were studied in 80 patients with chronic bronchitis. As a manifestation of the inflammatory response, nonsignificant increase was recorded compared to the group of healthy subjects. In discordance with literary data, no significant differences were found between bronchitics smokers and non-smokers. In 5 patients (6.2%), alpha 1-antitrypsin serum levels were below the lower limit of the reference range. The patients complained of cough, expectoration, and dyspnea. As a preventive measure, it is recommended to determine serum alpha 1-antitrypsin levels in smokers before they take up a job in a dusty environment and in bronchitics before inhalation treatment with proteolytic enzymes is administered. In alpha 1-antitrypsin deficit the value of substitution therapy in patients with emphysema is being emphasized.

Bronchitis↗
PubMed1989

[High-resolution computed tomography for diagnosing pulmonary complications in patients with lung cancer].

The diagnostic value of high-resolution computed tomography has been assessed in 10 lung cancer patients with pulmonary infiltrates. This method was used to evaluate the radiographic appearance of the new pulmonary disease. The expectorated sputum of each patient was examined for a bacteriologic and cytologic diagnosis. In some patients, the flexible bronchofiberscopy that was accompanied by bronchoalveolar lavage was performed so as to establish the etiologic diagnosis. In conclusion, high-resolution computed tomography was found to be useful in diagnosing pulmonary complications in lung cancer patients.

Adult↗
PubMed1989

[Fluoride retention and clearance after rinsing with fluoridated mouthwashes].

Oral fluoride clearance and oral fluoride retention were studied in 12 adult volunteers. 5 different mouthrinses were used. The test agents, in part available on the market, includes two Candida mouthrinses containing 1508 and 330 ppm F, respectively, Act containing 308 ppm F, a zinc fluoride-hexetidine (ZH) combination containing 287 ppm F, and an amine fluoride 297/SnF2 (AmF/SnF2) combination containing 241 ppm F. The volunteers rinsed with 10 ml of the above solutions for 30 s each. The oral fluoride concentration was reduced to 1 ppm 99 min after rinsing with Candida original. With the AmF/SnF2 solution, the oral fluoride concentration remained above 1 ppm for 39 min, and for about 20 min after rinsing with Candida reduced, ZH and Act. With both Candida original and ZH significant fluoride levels in the oral fluid were still found after 3 h, while with AmF/SnF2 and Act significant fluoride levels lasted for 2 h. A specific clearance value was determined for each mouthrinse, reflecting the ability of the agent to remain attached to the oral structures. The AmF/SnF2-rinse had a rapid clearance value. About 9 to 17% of the fluoride brought into the oral cavity were not expectorated. For the mouthrinses containing 0.05% NaF the retention was about 0.4 mg F. This value is considered to be harmless. Mouthrinses used after the application of a monofluorophosphate-dentifrice helped to increase the relatively low oral fluid fluoride level. Rinsing with the test agents after brushing with the amine fluoride dentifrice (Elmex) produced no significantly increased fluoride levels. In-between meals eliminated the oral fluoride concentration rapidly.

Adult↗
PubMedDate not supplied

Light and electron microscopic observations of blastomyces dermatitidis in sputum.

Freshly expectorated sputum from a 52-year-old man with extensive pulmonary blastomycosis was examined by light and electron microscopy. Wet preparations of the sputum, stained with 1% aqueous cresyl violet, revealed numerous thick-walled, spherical blastospores and occasional budding forms. Ultrastructurally, the blastospores revealed a double-layered cell wall, the peripheral portion of which consisted of a thick, densely staining lamellar material of variable thickness, suggestive of the glycocalyx of bacterial cells. Mitochrondria and other organelles were easily recognized, but distinct nuclei were not observed. Retraction of the cell membrane and cytoplasmic mass from the cell wall was a common finding. Results of this case study suggest that electron microscopy of sputum may serve as an important adjunct to conventional staining techniques for the presumptive diagnosis of blastomycosis. Similar studies of other fungi in respiratory tract secretions may be helpful in providing more precise morphologic identification.

Blastomyces↗
PubMed1987

A receptor-antibody sandwich assay for teicoplanin.

We have developed a new method for quantifying teicoplanin in complex matrixes, a receptor-antibody sandwich assay (RASA). The method is based on bioselective adsorption of teicoplanin onto microtiter plates coated with albumin-epsilon-aminocaproyl-D-alanyl-D-alanine, a synthetic analog of its biological target, and reaction with anti-teicoplanin antibodies. The sandwich complexes are detected by incubation with peroxidase-labeled goat antibodies to rabbit IgGs and chromogenic reaction with o-phenylenediamine. The dose-response curve was linear for teicoplanin concentrations in the range from 0 to 0.15 mg/L. We used the assay to measure teicoplanin concentrations in various biological matrixes. Analytical recovery from serum was 99.5%, the interassay CV was 5.1%, and the detection limit was 30 micrograms/L (P less than 0.01). Mean analytical recoveries from other biological specimens were 98% from ascitic fluid, 100% from pleuric liquid, 104.8% from prostate homogenate, and 98.5% from bronchial expectorate.

Anti-Bacterial Agents↗
PubMed1988

[Purulent pleurisy caused by anaerobic bacteria. A retrospective study of 19 cases].

A retrospective clinical, biological, radiological and evolutive study of 19 cases of pleural empyema caused by anaerobic organisms diagnosed between 1980 and 1986 was carried out. These 19 cases accounted for 30.6 p. 100 of all cases of pleural empyema diagnosed during the same period. A local or general contributory factor was found in all patients; false passage, gastrointestinal pathology and buccal or dental diseases were the most frequent aetiological circumstances. The clinical picture was rather torpid, with a body temperature below 38 degrees C in 42 p. 100 of the cases, which delayed the diagnosis: the mean time interval between onset and diagnosis was 20 days. In nearly one half of the cases, blood stained expectoration was present and air-fluid levels were visualized at standard radiography and computerized tomography, which is the best exploratory method to evaluate the size and appearance of the pleural lesion, to guide percutaneous drainage and later to assess possible sequelae. The predominant anaerobic flora consisted of Gram-positive cocci and Bacteroides spp; in 70 p. 100 of the cases the anaerobic organism(s) was (were) sensitive to penicillin G. The course of the disease was favourable in all patients. Surgery was performed in 3 of the 19 patients on account of chest wall gangrene due to Clostridium perfringens in 1 case and of the presence of multiple fluid pockets making drainage ineffective in 2 cases.

Adult↗
PubMed1988

Using the microbiology laboratory in the diagnosis of pneumonia.

Pneumonia/influenza is one of the top ten leading causes of mortality in the United States each year. The identification of the etiologic agent responsible for lower respiratory tract infection plays an important role in the proper management of this clinical problem. The specimens submitted for evaluation are obtained in diverse ways and include expectorated sputum, material from transtracheal and bronchoscopic procedures, pleural fluid and lung aspirates, and biopsy of actual lung tissue. Processing of material can include stained smears, aerobic and anaerobic cultures, and special processing techniques for fungal, viral, Pneumocystis carinii, Legionella, mycobacterial, and mycoplasma identification. Modifications of smear preparation techniques and application of the new DNA probe technology are providing the opportunity for rapid microbiologic testing of clinical specimens with increased sensitivity and specificity, often obviating the need for invasive diagnostic procedures. Laboratory methodology is continually undergoing technological change, and optimal care of the patient with pneumonia requires close cooperation between the attending physician and the clinical laboratory.

Bacteriological Techniques↗
PubMed1988

Diagnosis of pneumococcal pneumonia.

Pneumococcal pneumonia presents peculiar problems to the diagnostician. It is at once the most common form of community-acquired bacterial pneumonia and simultaneously the most difficult to document microbiologically. Bacteremia, empyema, meningitis, or septic arthritis due to S pneumoniae unmistakably verifies this bacterium as the cause of a coexistent pneumonia; this coexistence fortunately occurs infrequently. The diagnostic dilemma arises in the less sick patient. While recognizing the common presence of pneumococci in the oropharynx of healthy individuals, we give undue credence to S pneumoniae cultured from sputum obtained by expectoration. At the same time, pneumococci are frequently not found in cultures of sputum obtained from patients with confirmed bacteremic disease. More invasive techniques (transtracheal aspiration, protected bronchoscopic catheter, lung needle aspiration) are too complex, dangerous, or both for routine use. Attempts to detect pneumococcal antigen in blood, sputum, or urine by modern immunologic techniques give promise of avoiding the problems of either contamination or lack of bacteriologic growth. However, they have not yet been evaluated in sufficiently large groups with pneumonia of independently determined bacterial etiology to calculate test sensitivity and specificity. At the present time then, the careful clinician will use all the epidemiologic and clinical evidence at hand, including a careful Gram's stain and culturing of sputum, blood, and other sources, to arrive at the most likely etiology. The probabilities must be weighed in light of the imprecision of current laboratory confirmation and modified by clinical course. Choice of antimicrobial therapy still favor penicillin for patients with community pneumonia severe enough to warrant hospitalization, despite ominous trends in multiple resistance of S pneumoniae.

Anti-Bacterial Agents↗
PubMed1988

Acetylcysteine: a drug that is much more than a mucokinetic.

Acetylcysteine is the most widely used mucolytic drug, and it has greater documentation of effectiveness than any other mucokinetic agent. Originally it was used as an aerosol, but currently it is mostly prescribed by the oral route. In addition to the lytic activities of acetylcysteine, the aerosolized drug has bronchorrheic effects, while oral therapy results in expectorant and mucoregulator actions. Newer uses of the drug depend on its effectiveness as a free-radical scavenger, since it is a precursor of glutathione. It is well established as the drug of choice for treating acetaminophen poisoning, and it offers an important role in protecting the lungs from a variety of insults that result in oxidant damage.

Acetylcysteine↗
PubMed1988

Assessment of airways inflammation utilizing bronchoalveolar lavage.

Pathologic correlations and examination of expectorated sputum have suggested that chronic bronchitis is an inflammatory disorder of the airways. Bronchoscopy and bronchoalveolar lavage provide a means for sampling airway epithelial lining fluid. Application of bronchoscopy and bronchoalveolar lavage to a group of patients with chronic bronchitis confirms the association of airways inflammation and chronic bronchitis.

Bronchitis↗
PubMedDate not supplied

[Pseudomonas aeruginosa: immunotypes and drug resistance].

Serotyping of Pseudomonas aeruginosa by Fisher's schema has been used to study the prevalence of particular immunotypes among strains of P. aeruginosa obtained from clinical specimens. About 78% of the isolates were serotypable and about 22% were not. Immunotypes 2 and 6 turned out to be the most prevalent, whereas immunotypes 5 and 7 were the least frequent. Immunotypes 2, 5, 6 and 7 did not vary significantly as far as frequency in the various sources is concerned, with the exception of immunotype 2, which was significantly less frequent in isolates from the expectorated sputum. In such isolates immunotype 3 was significantly more frequent than in other sources, whereas immunotype 4 was significantly more frequent in isolates from the feces. It was next investigated whether a correlation exists between antibiotic susceptibility and particular immunotypes. A high percentage of the non-typable strains and of those belonging to immunotypes 2 and 6 proved to be resistant to the antimicrobial agents tested.

Humans↗
PubMed1988

Sputum examination in the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome.

To examine the role of sputum examination in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS), we conducted a prospective study of 30 patients with AIDS or suspected AIDS. Sputum was obtained just prior to bronchoscopy by spontaneous cough (20 patients) or by induction with a saline nebulizer (ten patients). Pneumocystis carinii was diagnosed by bronchoalveolar lavage in 13 of the 30 patients; two of these patients had P carinii organisms identified in sputum specimens (sensitivity of sputum, 15.3%; negative predictive value, 60.7%). A cost-analysis study demonstrated that sputum examination is not cost effective when the sensitivity is below 24%. We conclude that P carinii can be diagnosed from expectorated sputum in patients with AIDS, but, because of the test's low sensitivity, it cannot be recommended in the routine evaluation of patients with AIDS and pulmonary complaints.

Acquired Immunodeficiency Syndrome↗
PubMed1988

The pathogenic potential of Sporotrichum pruinosum isolated from the human respiratory tract.

The repeated occurrence of Sporotrichum pruinosum, demonstrated by direct microscopy and culture, is reported from the respiratory tract of three patients who complained of cough, expectoration of sputum, dyspnoea and occasional pyrexia. This observation coupled with the presence of immediate, type I, cutaneous hypersensitivity against S. pruinosum in two of the patients and the ability of the fungus to incite lesions in experimentally infected mice supported an etiologic relationship between the fungus and the patients' symptoms. The macroscopic and microscopic characters of one of the clinical isolates of S. pruinosum are briefly described. It is suggested that the isolation of S. pruinosum from clinical specimens should not be regarded as of no etiologic significance without careful clinical and laboratory evaluation of the patient.

Adult↗
PubMed1988

[Pulmonary tests in the office of the internist/general practitioner].

The x-ray and pulmonary function equipment of most Swiss private practitioners should be sufficient to diagnose and treat most ambulatory pulmonary diseases. More knowledge about chest x-ray technique and a well performed forced vital capacity manoeuvre will improve both of their interpretation. Furthermore, a Mantoux test correctly done and interpreted, a simple pleural punction and a quick method of the usual Gram stain of purulent expectorations complete the choice of possible investigations in the ambulatory medicine.

Bronchial Provocation Tests↗