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PubMed1987

Aspiration of a tracheostomy plug.

A plastic truncated conical tracheostomy plug passed down the outer cannula of a Jackson tracheostomy tube and into the lungs of a respirator-dependent man during the monthly change of the inner cannula. Despite repeated flexible and rigid bronchoscopic visualization, attempts at dislodgement were unsuccessful. An exploratory thoracotomy was also unsuccessful in recovering the plug. Seventeen days postaspiration, with percussion and postural drainage, the patient expectorated the plug, even in the absence of the cough reflex. Such plugs have now been modified by passing a ring through the hole to prevent aspiration.

Bronchi↗
PubMed1987

Aerial respiration facilitates growth in suspension-feeding anuran larvae (Xenopus laevis).

Xenopus laevis tadpoles are midwater suspension-feeders that use buccopharyngeal surfaces for both food capture and aquatic respiration, but also have functioning lungs well before metamorphosis. To examine the effect of aerial respiration on premetamorphic growth and development in this species, tadpoles were raised in normoxic water for from one to three weeks at three different concentrations of food (yeast cells in suspension). At each food concentration the larvae were either allowed or denied access to air. Xenopus larvae reached greater snout-vent lengths, weighed more and developed more rapidly when allowed to breathe air. The difference in growth and development between those tadpoles with and without access to air was proportional to the concentration of particulate matter. In the extreme, tadpoles denied access to air at the highest food concentration all asphyxiated shortly after the start of the experiment. Xenopus tadpoles faced with the functional conflict of using buccopharyngeal surfaces for both feeding and respiration retard ingestion. They do this, however, not by ceasing mucus outflow to their branchial food traps, as has been speculated previously, but rather by capturing food particles in mucus and then expectorating it. Lungs appear to be advantageous to aquatic organisms even in normoxic water in that they allow buccopharyngeal surfaces to be dedicated fully to feeding rather than respiration.

Air↗
PubMed1987

[Primary pulmonary leiomyosarcoma. Review of the literature apropos of a case].

A 55-year-old patient with primary pulmonary leiomyosarcoma was treated by pneumonectomy. The diagnosis was established by histology of the operative piece. Bronchoscopy and cytology of expectorations were negative. This rare tumor (fewer than 100 cases described) differs from bronchial carcinoma by its method of spread, mainly hematogenic, and its better prognosis. clinical and radiographic data do not provide differential diagnoses. Treatment is essentially surgical since the tumor is only weakly radio-sensitive and responds poorly to chemotherapy.

Humans↗
PubMed1987

[Pulmonary infection caused by a rare mycobacterium, Mycobacterium malmoënse].

The present case report is on a patient treated for tubercle in 1949 by an artificial pneumothorax. Thirty three years after the initial illness some radiological changes occurred suggesting a recurrence, especially as a bacteriological examination showed the presence of acid-alcohol fast bacilli on direct smear. Triple therapy (Isoniazid, Rifampicin, Streptomycin) was then prescribed, and was followed by a radiological improvement, even though the sputum remained positive. After multiple seedings, it was possible to isolate from 11 tubes and 2 expectorations a rare strain of mycobacterium: mycobacterium malmoense. The present observation seems to be the first indisputable French case of infection by this bacterium. From the opportunity presented by this observation the bacteriological characteristic of this mycobacterium, as well as the clinic aspects of the infection are discussed.

Humans↗
PubMed1987

Ambroxol plus amoxicillin in the treatment of exacerbations of chronic bronchitis.

Twenty-three patients with exacerbations of chronic bronchitis were divided in two groups in a randomized fashion receiving either amoxicillin 1500 mg/d (n = 13) or amoxicillin 1500 mg/d associated with the mucolytic drug ambroxol 90 mg/d (n = 10). The improvement in cough, expectoration difficulties and sputum purulence was statistically more evident and occurred earlier in the ambroxol + amoxicillin group than in the amoxicillin only group. Although amoxicillin plasma and sputum levels were similar in both groups, the differences in daily sputum volume, which was also statistically greater in patients receiving ambroxol, suggests that this drug favours the bronchial mucus clearance of the antibiotic which could be related to the more favourable clinical evolution. No changes were observed in lung function tests and blood gases.

Adult↗
PubMed1978

[Clinical results in the treatment of chronic obstructive bronchitis with ambroxol in comparison with bromhexine (author's transl)].

Preclinical studies of trans-4-[(2-amino-3,5-dibromobenzyl)-amino]-cyclohexanol hydrochloride (ambroxol, NA 872), the metabolite VIII of bromhexine, show that it is superior to the basic substance with respect to its bronchosecretolytic properties. In a double blind study 30 patients suffering from chronic obstructive bronchitis received in randomized order 36 mg bromhexine/d or 45 mg ambroxol/d, each over a period of 4 weeks. The following parameters were studied: mean bronchial flow resistance, forced expiratory volume, static lung volumes, arterial blood gases as well as clinical and laboratory results. Bromhexine was not associated with a change in lung function parameters. Ambroxol was associated with a 25% reduction of the average bronchial flow resistance. The forced expiratory volume improved over the period on the average by 14%. Patients with slight arterial hypoxemia had an increase in the partial pressure of arterial oxygen. The patients found both substances facilitated expectoration. Further studies appear necessary to confirm the improved respiratory performance under the influence of ambroxol.

Adult↗
PubMed1986

[Kaposi's sarcoma of the larynx].

Kaposi's sarcoma of the larynx is a rarely observed manifestation of AIDS. Possible concomitant symptoms are hoarseness up to aphonia, urge to cough or stridor. Expectoration of small parts of tissue of Kaposi's sarcoma may be an additional sign. Similar to Kaposi's sarcoma in the oral cavity Kaposi's sarcoma of the larynx is characterised by a purplish, spongy nodule. Its surface can be verrucous due to deposits of dry secretion. Local extirpation of Kaposi's sarcoma removes the laryngeal signs and symptoms.

Acquired Immunodeficiency Syndrome↗
PubMed1986

The treatment of acute transient cough: a placebo-controlled comparison of dextromethorphan and dextromethorphan-beta 2-sympathomimetic combination.

The efficacy of an antitussive-beta 2-sympathomimetic combination (dextromethorphan-salbutamol) was compared with that of a plain antitussive (dextromethorphan) and a placebo in a double-blind trial in 108 out-patients with cough associated with acute respiratory infection. The dextromethorphan-salbutamol combination was superior to dextromethorphan or placebo in the suppression of cough at night, although a spontaneous improvement occurred in all treatment groups during the 4-day treatment period. No statistically significant differences between the treatments were shown in the symptom scores for the cough frequency and severity during the day, sputum quantity or ease of expectoration. A significant improvement in cough during the day was observed in all treatment groups. The results suggest that the use of antitussives is usually unnecessary; the only indication might be symptomatic relief, especially at night. An antitussive combined with a beta 2-sympathomimetic might be the most effective treatment in this type of cough.

Acute Disease↗
PubMed1986

[Cavernous bronchus carcinoma].

In thoracic surgery patients the etiology of cavities has drastically changed in the last 20 years. While at present only very few patients need surgery for cavernous tuberculosis, cavities of cancerous origin are becoming more and more frequent. During the period from 1977 to 1985 24 out of 225 bronchogenic carcinomas treated by resection were found to be cavernous (10.7%). Radiologically the degree of cavitation extended from a small marginal or central air collection to the formation of large, irregular, and thick-walled caverns. The excavation is the result of necrobiotic changes within the tumor. It arises when the tumor masses penetrate into the bronchial tree and are expectorated. However, prognosis of cavitated cancer remains exclusively dependent on the stage of the tumor. The cavitation itself seems not to influence it.

Carcinoma, Bronchogenic↗
PubMed1986

The value of the forced expiration technique with and without postural drainage in adults with cystic fibrosis.

The effect of the Forced Expiration Technique (FET) with or without Postural Drainage (PD) was examined in eight adults with cystic fibrosis. On four mornings the patients followed a 30-min physiotherapy session consisting in a randomized order of either FET in a sitting position following a night of horizontal sleep ("FET"), or FET in a postural drainage position following sleep including postural drainage ("FET/PD"). The lung function parameters studied did not change during either of the two treatments. Sputum yield over 22.5 h before the physiotherapy sessions and over 24 h increased with PD during sleep in patients with more than 30 g of sputum per 24 h (p less than 0.05). PD during the treatment sessions did not further increase sputum production. This study indicates that sleeping head-down improves expectoration in patients with copious sputum. PD during FET is not needed after sleeping in the head-down position.

Adolescent↗
PubMed1985

Combined cefuroxime plus acetylcysteine in the treatment of bacterial infections of the respiratory tract.

Fifty adult patients (29 males, 21 females) suffering from respiratory tract infections with substantial production of mucus were treated with cefuroxime 1 g and acetylcysteine 300 mg administered simultaneously by i.m. injection twice daily for 10 days. Bacteriological tests were performed before and after treatment. Clinical variables (fever, cough, quantity and type of sputum, difficulty in expectorating) were evaluated, and assigned scores ranging from 0 to 3 according to an arbitrary semiquantitative scoring system. The therapeutic results obtained were positive. No side-effects were observed.

Acetylcysteine↗
PubMedDate not supplied

Positive expiratory pressure (PEP-mask) physiotherapy improves ventilation and reduces volume of trapped gas in cystic fibrosis.

To investigate the lung function during positive expiratory pressure (PEP) physiotherapy in cystic fibrosis, the resistance tube of the PEP-mask was inserted into the expiratory outlet of our lung function equipment. This enabled us to measure a variety of lung function variables, while the lung function equipment functioned as a PEP-mask. We studied 12 patients and found that during PEP-mask physiotherapy functional residual capacity (FRC) increased significantly (p less than 0.02). There was a decrease of washout volume (WOV) (p less than 0.05), lung clearance index (WOV/FRC) (p less than 0.001) and volume of trapped gas (p less than 0.05), whereas total lung capacity, vital capacity, tidal volume and residual volume did not change significantly. It is concluded that in cystic fibrosis PEP-mask physiotherapy evens the intrapulmonary distribution of the ventilation and opens up regions, that are otherwise closed off. The results support the clinical observation that PEP-mask physiotherapy increases the transcutaneous tension of oxygen and the expectoration of sputum.

Adolescent↗
PubMed1985

[Gastroesophageal reflux and nocturnal broncho-aspiration in chronic bronchopathies].

Although the relationship between chronic bronchopathies and gastro-esophageal reflux is known, the existence and role of nocturnal broncho-aspiration is controversial. 32 patients with chronic bronchopathy and 13 controls without digestive or respiratory symptoms were studied. Nocturnal broncho-aspiration was diagnosed by the demonstration of vegetable fibers in the morning expectorate and by the presence of radioactive pulmonary foci 15 hours following an isotopic meal. Vegetable fibers were found with equal frequency in both groups. On the other hand, positive pulmonary scintigraphy, reflecting nocturnal broncho-aspiration, was observed in 24 of the 32 patients (75%) and only in 2 of the 13 controls (15%) (p less than 0.001). Thus, broncho-aspiration is a frequent occurrence in chronic bronchopathies.

Adult↗
PubMedDate not supplied

[A controlled clinical study of Pneumorel Retard tablets in the treatment of chronic bronchitis (author's transl)].

The authors studied the action of Pneumorel retard tablets in the treatment of chronic bronchitis, comparing 2 groups of 20 patients each, one group was prescribed 1 pneumorel retard tablet in the morning and evening and the other group was treated with a speciality associating proteolytic enzymes and balsamics; the 2 groups also received an antibiotic treatment. The duration of the treatments was 20 days, with controls at entry, 10 days and 20 days later. Pneumorel retard showed to be significantly more active on the criteria studied (cough, dyspnea, expectoration, signs of auscultation) and this more often than not from the 10th day of treatment. Clinical and biological tolerance was perfect concerning the hepatic sphere, gastrointestinal, renal or cardiovascular systems. The convenience of the use of Pneumorel retard is particularly indicated in the thorough long-term treatment of chronic bronchitis, in preventing episodes of over-infection, worsening the disease.

Adolescent↗
PubMed1986

[Clinical manifestations of tuberculosis today].

In developed countries tuberculosis has not yet been eradicated and diagnostic problems still remain. The purpose of this study was to analyze the clinical pattern, epidemiological data and risk factors in 85 patients (59 males and 26 females, mean age 41 +/- 15 years) seen from 1975-1984 in the medical outpatient clinic of Basle with the diagnosis of tuberculosis. The organ distribution of the tuberculosis was as following: lung n = 54, cervical lymph nodes n = 9, pleura n = 7, peritoneum n = 3, endometrium n = 2, bones n = 2, pericardium n = 1, middle ear n = 1, urinary tract n = 1, skin n = 1, cerebrum n = 1, miliary tuberculosis n = 3. In the younger age group (20-40 years) cervical lymph node tuberculosis predominated, whereas in the age group over 50 pulmonary tuberculosis was most frequent. The leading symptoms were: cough (59%), expectoration (48%), fever (39%), night sweat (24%). Risk factors were: cigarette smoking in 51%, alcoholism in 37%, preexisting lung disease in 20%, past tuberculosis in 19%. In pulmonary tuberculosis the most accurate diagnostic procedure was examination of bronchial secretion, followed by examination of sputum and gastric juice. Histological examination was the most appropriate procedure in tuberculosis of lymph nodes and peritoneum. In all patients treatment was as follows: isoniacid (INH), rifampicin and ethambutol for the first 4 months, followed by isoniacid and ethambutol for 6-10 months. In summary, tuberculosis has no typical clinical pattern and biochemical tests are unhelpful in establishing diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Drugs for cough and cold symptoms in hypertensive patients.

Most cold preparations contain sympathomimetic decongestants in combination with antihistamines, anticholinergics or expectorants. All of the sympathomimetic decongestants have the potential to elevate blood pressure, yet little information has been reported on their use in patients with hypertension. Phenylephrine and phenylpropanolamine stimulate alpha-adrenergic receptors, causing elevation of blood pressure and a reflex decrease in heart rate. Ephedrine and pseudoephedrine stimulate both alpha and beta receptors, elevating blood pressure with an increase or no change in heart rate. Because little is clinically known, these agents should probably be avoided in hypertensives.

Antitussive Agents↗
PubMed1985

Bronchoesophageal fistula caused by pulmonary aspergillosis.

A 29-year-old patient developed a bronchoesophageal fistula after expectorating a mycetoma caused by Aspergillus fumigatus. After failure of medical therapy, a retrosternal coloplasty was performed. Pulmonary aspergillosis can be the cause of a bronchoesophageal fistula.

Adult↗