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Extended cervical esophagomyotomy for cricopharyngeal dysfunction.

Forty adult patients have undergone a 7 to 10 cm cervical esophagomyotomy (from the superior cornu of the thyroid cartilage to behind the clavicle) for cricopharyngeal dysfunction. A Zenker's diverticulum was present in 12 patients (30%) and in five was recurrent. Preoperative symptoms included cervical dysphagia (85%), expectoration of saliva (40%), and intermittent hoarseness (30%). Four patients were being fed through tubes because of total inability to swallow. "Heartburn" was experienced by one half of the patients, but only 12 had acid or food regurgitation. The duration of symptoms ranged from 1 month to 11 years (average 3.9 years). Weight loss had occurred in 15 patients (38%) and ranged from 5.5 to 40.9 kg (average 16 kg). Barium swallows showed no abnormalities in 10 patients. Abnormal findings included a Zenker's diverticulum (12), prominent cricopharyngeal sphincter (11), nasopharyngeal reflux or incoordinated initiation of deglutition, or both (seven), a sliding hiatal hernia (11), and abnormal esophageal motility (seven). Esophageal manometry revealed abnormalities of upper esophageal sphincter (UES) function in only 16 patients. Of 36 patients undergoing standard acid reflux testing, one third had moderate-to-severe gastroesophageal reflux. Seven patients underwent staple resection of a Zenker's diverticulum at the time of cervical esophagomyotomy. Postoperative complications included transient vocal cord paresis (four), vocal cord paralysis (one), and salivary fistula (one). There were no postoperative deaths. After 2 to 48 months (average 16 months) of follow-up, 34 patients (85%) have had a good to excellent result, and six (15%) have not been benefited by operation.

Adult↗

Cutaneous mycobacteriosis: analysis of 34 cases with a new classification of the disease.

Several points can be made from analysis of the published cases of cutaneous mycobacteriosis and those in our series: 1) mycobacterial cutaneous infections are probably more common than is reported-we collected 34 cases over a 10-year period; 2) most patients with cutaneous infections caused by nontuberculous mycobacteria have significant underlying disease; 3) there is a relative lack of classic histologic features in patients with cutaneous mycobacteriosis, and there appear to be diverse forms of clinical presentation; 4) a high index of suspicion is needed in evaluating patients with possible cutaneous mycobacteriosis, and appropriate cultures must be done to establish the diagnosis. In attempting to provide a practical classification of cutaneous mycobacteriosis which includes infection by nontuberculous mycobacteria, we propose the following grouping, which uses simple terms, avoids confusing nomenclature, and incorporates pathophysiologic descriptions and prognostic information: 1) Mycobacteriosis caused by inoculation from an exogenous source. 2) Cutaneous mycobacteriosis caused by spread from an endogenous source. Contiguous spread originates most often with osteomyelitis, but also occurs through autoinoculation of the perirectal, oral, or vaginal skin as organisms are passed or expectorated from pulmonary or genitourinary tuberculosis. 3) Cutaneous mycobacteriosis caused by hematogenous spread. This group includes lupus vulgaris, nodules and abscesses, and acute disease with hemorrhagic pustules. Some mycobacterioses will be difficult to classify when inoculation or hematogenous spread cannot be ruled out. However, the system of classification we have proposed should help clinicians understand and diagnose the diverse forms of cutaneous mycobacterial infections.

Adult↗

[Health conditions of a group of factory arc welders].

73 welders were examined, who weld in an assembly room of a machine factory, mainly by an electric arc. In anamneses 60% of persons under examination notified of coughing, expectorating, dyspnoea during work, and frequent acute rhinitis. Clinical symptoms of respiratory tract disease, resulting from welding, were found in 10% of welders. Simple bronchitis, resistant bronchitis with pulmonary emphysema, pleural adhesions were diagnosed. In one case fibronodular tuberculosis was found (1%). In 8% of workers, aged 40--50, a dynamic arterial hypertension and radiological symptoms of aortosclerosis were found. 5% welders had granulocytopenia. Disturbances of the examined systems occurred in factory welders with duration of employment above 10 years.

Adult↗

[Experimental study of the effects of bromelain on the sputum consistency in rabbits].

Effects of bromelain (BR) on rabbit sputum consistency were investigated in vitro and in vivo. On the sputum showing relatively low viscosity, BR and other enzymes such as serratiopeptidase (SP), the mixed preparation of pronase and pancreatin, and lysozyme exerted lowering effects; and the effect of BR was the most potent. However, bromhexine had virtually no effect. On the sputum showing relatively high viscosity, BR exerted more potent lowering effects on the viscosity and yield value of sputum than those of SP. Furthermore, 320,000 U/head BR and 120,000 U/head SP lowered the viscosity significantly and yield value of sputum in rabbits with oral administration for 3 days. The lowering effect on the yield value of BR was more potent than that of SP. BR also increased the sputum volume in rabbits. BR and SP showed tendencies to decrease the contents of acid glycoprotein and sialic acid in sputum. It can be considered that these results support the effectiveness of BR as an expectorant in clinical use.

Administration, Oral↗

[Radioimmunologic assay of the major basic protein of eosinophilic granules in sputum. A diagnostic contribution in asthma].

The concentration of major basic protein (MBP) of the eosinophilic granules in bronchial expectoration (Sputum) were measured by radioimmunoassay in 204 subjects suffering from various illnesses of both the respiratory tract and other systems. 31 of these subjects were later revealed to have asthma and all had very high sputum MBP levels. The MBP level was much greater in asthmatics than any other respiratory or non-respiratory ailment and in a statistically significant fashion (p less than 0.001). 25 other subjects who were in hospital for exacerbations of asthma were subsequently tested; their MBP concentrations were higher still. During the course of their hospital stay the sputum MBP levels fell significantly following treatment with steroids and broncho-dilators. The measurement of the MBP level would seem useful in those situations where the diagnosis of asthma is not evident from the history and may help in predicting the effectiveness of steroid treatment.

Animals↗

Chest physiotherapy and airway obstruction in patients with cystic fibrosis - a negative report.

In 24 patients with cystic fibrosis (6-20 years old), divided into two groups, we studied indices of airways obstruction before, 20-30 min and 2 h after chest physiotherapy. The physiotherapy lasted for 30 min and included expectoration of 2-10 ml of sputum. In one group of 14 patients, studies were made only 30 min after chest physiotherapy. No significant improvements of the ventilatory tests occurred. In fact, Vmax at 25% of VC deteriorated (P less than 0.05) in this group as a whole. In some patients also CV/VC increased, and N2 and CO2 alveolar slopes became steeper. Only Gaw/TGV improved in 20% of the patients by more than 10% of the control value. In the second group of 10 patients, ventilatory studies were repeated 3 times at one month intervals. They did not change significantly at 20 min and 2 h after chest physiotherapy. Gaw/TGV value improved by more than 10% in 20% of the patients. During chest physiotherapy, the patients were stimulated to cough. This might contribute to the immediate negative effects on ventilatory function by causing collapse of the central airways, as documented by cinebronchographic studies in 8 patients.

Adolescent↗

[The use of guacetisal in chronic obstructive bronchopneumopathy. Controlled clinical study].

A single-blind, between-patients trial was run to compare the fluidifying, expectorant, antitussive, antipyretic and anti-inflammatory activity, and the local and systemic tolerance of guacetisal, an active principle obtained by the esterification of acetylsalicylic acid and guaiacol, and oxolamine phosphate, in which the suspension formulation for adults was administered to 30 presenile and senile patients of both sexes with chronic obstructive bronchopathy. A higher activity on the part of guacetisal was noted. The results obtained are illustrated and discussed.

Aged↗

[Clinico-functional observations on the use of guacetisal in the treatment of chronic obstructive bronchopneumopathy].

The results of an approximately 14-day treatment with 500 mg broncaspin capsules in 25 patients with recrudescent chronic bronchitis are presented. There was a marked, constant improvement in the subjective and objective symptomatology, and in respiratory function indices. The expectoration cell parameters displayed changes consonant with the therapeutic effect. Local and general tolerance were good overall.

Adult↗

[Clinical trials of a new preparation in chronic bronchopneumopathies].

The new preparation Broncaspin (guacetisal) has been experimented in the form of 1.2 g suppositories and 5% suspension, in 40 patients suffering from chronic bronchopneumopathy at acute phase. The drug exerted a marked therapeutic action in objective and subjective symptomatology in 87.5% of cases. The action was manifold in relation to the typical expectorant fluidifying, bronchiole disobstructing and anti-inflammatory characteristics of the drug. Tolerance was always excellent.

Adult↗

[Morphological aspects of non-tumoral bronchial cells recovered by brushing (author's transl)].

A series of 132 bronchial brushings studied according to a strict protocol, both in obtaining the specimens and their subsequent laboratory preparation, has allowed us to study the cells of the bronchial mucosa in greater detail. Until now the greater part of the work in this field has been on the characteristics of tumour cells and the variability in detecting cancer, slightly neglecting the analysis of normal, inflammatory or dystrophic cells. The brushings were compared to the cytology requests on sputum and/or corresponding aspirations by conventional methods. This work has shown that the different types of normal epithelial cells so recovered, as well as dystrophic cells, have a very different appearance than those same cells when observed using classical cytological methods (on sputa and aspirations). The cyto-pathologist ought to adjust the technique before interpreting the specimens. The differences are due to a better state of conservation of the recovered cells, thanks to improvement in current endoscopic technique. We infer that certain cytological appearances considered pathological until now, using classical expectoration or aspiration, may in reality only be artefacts.

Bronchi↗

Serum antibodies and immunoglobulins in smokers and nonsmokers.

Antibodies to antigens in humidifier water were detected by double immunodiffusion in 30 of 63 (47.6%) persons who were exposed to aerosols from a water humidification unit in a cigar plant, whereas no antibodies could be detected in 49 unexposed blood donors (P less than 0.001). The presence of antibodies could not be related to fever or pulmonary symptoms (cough, expectoration, dyspnoe). Antibodies were found in 14 (93.3%) of 15 nonsmokers and in only 13 (31.7%) of 41 smokers (P less than 0.001), and the titres were highest in nonsmokers. Serum IgG and IgA levels were higher in nonsmokers than in smokers, and the variances within the groups were significantly different (F less than 0.05 and F less than 0.05, respectively). The mean serum IgM values were not significantly different in the two groups. Antibodies to Candida albicans and Escherichia coli 04 and 075 were detected with equal prevalences and titres in smokers and nonsmokers. These findings suggest that tobacco smoking may suppress the humoral immune response to inhaled antigens but not to antigens which are supposed to be absorbed through membranes other than those of the bronchopulmonary system. They may partly explain the reported increased incidence of allergic alveolitis in nonsmokers.

Adolescent↗

Pharmacokinetic behavior of S-carboxymethylcysteine-Lys in patients with chronic bronchitis.

A mass fragmentographic technique was used to study the pharmacokinetic behavior of SCMC-Lys in patients with acute exacerbations of chronic bronchitis and with dense expectoration. Serum and urine levels, as well as bronchial mucus levels and their correlations, were determined. The data suggest that SCMC-Lys diffuses well into bronchial mucus, a useful feature for a mucolytic drug.

Bronchi↗

[Broncholithiasis].

Eight cases of broncholithiasis requiring surgical treatment are reported, and diagnostic and therapeutic difficulties of this affection discussed. Clinical symptomatology is not very specific and associates slight or moderate hemoptyses with signs of a febrile pulmonary disorder. Expectoration of a broncholith was not observed in these cases. Radiological images were suggestive by demonstrating hilar and/or peripheral calcifications, often with a parenchymatous opacity in the same region. Fibroscopy is not always conclusive and may even suggest the presence of a tumor. A tuberculous etiology is admitted in France in spite of the absence of bacilli in the sputum. Differential diagnosis from cancer is a real problem, this explaining why two pneumonectomies were performed, in addition to the six lobectomies.

Adult↗

[Combination preparations on the West German market].

The role of fixed drug combinations in FRG was analyzed: 1. The overall fraction of combinations in the categories analyzed was 70% ranging from 24 to 94%. 2. The number of active ingredients runs up to 27 in one drug marketed in the FRG. Combinations with many ingredients were particularly found in the categories of analgesics, cold medications and expectorants. 3. The fraction of drug combinations is less in the top 100 in 1981, but increases continuously in the following ranks. 4. Under the new Medicines Act of 1976 the fraction of drug combinations newly introduced in FRG initially decreased, but now it is increasing again. At the same time the number of approvals of products containing recently developed ingredients goes downwards. 5. As compared to Sweden, Great Britain and USA drug combinations play an important role in the FRG, accounting for almost 70% of the market. The present analysis indicates no decreasing trend.

Drug Combinations↗

[Clinical examinations of hemoptysis in chronic inflammatory bronchial diseases].

It is reported on 150 patients who were clinically examined due to expectoration of blood, of whom 103 under went a bronchological diagnostics immediately after hospitalisation. As to the frequencies of causes the tuberculosis occupies the first place, then follows the chronic bronchitis. The frequency of tuberculosis is reached by the chronic unspecific inflammation of the bronchial wall, when the disease groups characterized by symptom - chronic bronchitis, bronchectasia, infected bronchiolectatic honeycomb lung - are united to one collective. The experiences show that by means of endobronchial haemostasis including the tamponade of the bronchus surgical interventions in bleedings of the lung may be avoided, apart form rare exceptions.

Bronchitis↗

[On the evaluation of health factors in high-rise buildings. 2. Bioclimatological consequences resulting from comparative measurements of the air ionisation in a high-rise building located in a heavily contaminated suburban area and at certain altitudes (author's transl)].

According to accepted scientific theories inhaled small ions deliver their charges in the pulmonary alveoli and this leads to local recharges. This process stimulates structures of the central nervous system and the activity of the endocrine is excited, resulting in an enhancement of the general well-being. These possibilities of interpretation regarding a biological ionic effect are supported, with reservations (e.g. effects produced by a change in climate), by positive medical effects during and after a stay in a well-ventilated mountain climate or also in a sea-climate. Owing to their lower mobility the large ions are inhaled as small ions to an increasing extent. The chemical and physical noxa are delivered and deposited in the respiratory tract. They "stick" the epithelia in the trachea and in the bronchi as well as the endothelia in the lung vesicles. The number of the ciliary movements is reduced. Similar effects are known to be caused also by nicotine abuse. This results in a decreased ability of expectoration and a lower intake of oxygen by the alveoli. These facts could furnish an explanation for the increased vulnerability of city dwellers to infections diseases and to catarrh. The changed ionisation of air in urbanised areas (mainly large ions in high concentrations) definitely represents only one of the many risk factors. In addition to the attempt to characterize bioclimatically local weather conditions by means of the non-conventional parameter "air ionisation" our study has also been intended to establish biologically oriented criteria for the living in a high-rise building in a particularly unfavourable location. Under specific microclimatic conditions the uppermost storeys were at times bioclimatically favoured over the lowermost, especially when shallow air inversion is present. In such cases, small ions exclusively were registered in the upper storeys and large ions in the lower floors.

Air Ionization↗

[Clinico-functional data concerning chronic asthmatic bronchitis patients treated wih guacetisal].

Guacetisal was administered to a group of patients suffering from chronic asthmatic bronchitis. The drug in question was shown to possess a good fluidifying, expectorant and indirect anti-cough action, by means of an initial increase of the bronchial secretions and a subsequent progressive decrease of secretions towards the end of the treatment. The analysis of the respiratory parameters examined showed no modifications of statistical significance.

Adult↗

[A study of the diffusion of cefamandole into bronchial secretions (author's transl)].

The penetration of cefamandole into bronchial secretions was investigated in 5 tracheostomized patients with respiratory tract infections and purulent or mucopurulent expectorations. Bronchial secretions were collected by aspiration through the cannula at successive predetermined times after an intravenous injection of 1.5 g of the drug. Cefamandole concentrations in simultaneous samples of serum and bronchial secretions were measured by the agar diffusion microbiological method. Useful concentrations of cefamandole were obtained in bronchial secretions, with an early peak (mean: 1.97 microgram/ml; range: 0.5 -- 4.6 microgram/ml) one hour after the injection. The ratio of bronchial concentration to simultaneous serum concentration reached 24% six hours after the injection. These results show that cefamandole achieves bronchial concentrations which are superior, or at least equal, to the MICs of organisms responsible for respiratory infections. This and the resistance of cefamandole to beta -lactamases suggest that this second generation cephalosporin can be valuable in acute bronchopulmonary infections.

Aged↗