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PubMed1981

[Cardiorespiratory function in young bronchitis patients, mostly mineworkers, before and after kinesitherapy and exertion training. Comparison with a control group (Preliminary results)].

We have studied the effects of respiratory physiotherapy and physical training on the cardiopulmonary function of patients with early chronic bronchitis and broncho-obstruction presumably at the beginning stages. The trained group was compared with a control group who was treated with infra-red rays on the thorax. Both groups were treated during four weeks. All patients were less than 50 years old and all were smokers. They complained of dyspnea on exertion (stage 2 ECCS), cough and expectoration for at least one year. Their spirometry and airway resistance values were normal or near normal but at least two of the following functional indices were altered in all: the He residual volume, the slope of N2 phase III and/or the He bolus phase IV. In the trained group, functional indices of central or peripheral airway obstruction did not change after the four weeks of treatment. On the contrary, the slow vital capacity (SVC) and the peak expiratory flow (PEF), which are presumably more influenced by the force of respiratory muscles, were significantly increased after respiratory rehabilitation. During steady-state exercise of moderate intensity 1.) a slight increase of pH (P less than 0.1 at a VO2 of 1.5 l/min and 1.75 l/min), perhaps due to a lessened lactacidemia, 2.) a decrease in ventilation (VE) (P less than 0.1 at a VO2 of 1.25 l/min) and 3.) a reduction in the alveolo-arterial gradient (AaDO2) (P less than 0.1 at a VO2 of 1.25 l/min) were observed. In the control group there was no change of respiratory functional indices at rest or during exercise after treatment. The reduction of AaDO2 observed in the trained group could be due to an improvement of pulmonary gas exchange. This was small, however, and probably without clinical significance. We believe that the improvement of dyspnea noted in the trained group could be due to the increase in ventilatory performance (SVC, PEF and VE) and to a better O2 extraction in the peripheral muscles.

Adult↗
PubMed1981

[Relationship between work in nitrogen-processing plants and chronic bronchitis including bronchial hypersensitivity].

The examination involved 55 men exposed to NH3, 60 exposed to NO2 and NH3 and 98 controls. Symptoms of chronic cough and (or) expectoration were found in 8 controls and 18 exposed workers. Significant differences refer only to smokers. Bronchial overreactivity was found in 23.5% controls and in 21.1% of those exposed. The authors conclude that in smokers exposed to NO2 and NH3 chronic bronchitis prevalence is greater whereas occupational exposure did not contribute to an increased number of those suffering from bronchial overreactivity.

Adult↗
PubMed1981

The wandering broncholith.

In a patient with "stone asthma" the obstructing broncholith moved from one lung to the other and was later spontaneously expectorated.

Bronchial Diseases↗
PubMed1981

[Clinical findings of cefoxitin in the treatment of serious infections and the prevention of postoperative infections (author's transl)].

UNLABELLED: This clinical trial was designed to evaluate the efficacy, safety and patient tolerance of cefoxitin in 23 patients who were admitted to the hospital from March 1980 to November 1980. The daily dose of cefoxitin for 21 adult patients (ages ranged from 26 to 74 years old) were 6 g for the treatment of infections, and 2 to 6 g for the prevention of infections by either direct or intermittent intravenous infusions. Two children were given 100 mg/kg of cefoxitin either by direct or intermittent intravenous infusions 2 to 3 times a day in divided doses. SUMMARY OF FINDINGS: I. Treatment of intracranial infections 1. A 60-year-old man with a brain abscess was admitted to the hospital after the unsuccessful treatment with a cephalothin for 9 days. After, the initiation of therapy with cefoxitin, given 6 g a day for 3 days, the abscess was surgically removed. On the second day of treatment with cefoxitin following the operation, his highest temperature was 37.0 degrees C and was normal on the third day of treatment. He was discharged after 12 days after the surgical procedure. 2. A 56-year-old woman with cerebrospinal rhinorrhea and meningitis after the transsphenoidal removal of pituitary microadenoma responded satisfactorily to therapy with cefoxitin, given 6 g a day for 14 days after the unsuccessful treatment with a cephalothin. II. The prevention of infections following surgical operation of the central nervous system 1. Seventeen patients undergoing surgical procedures were treated with cefoxitin for the prevention of postoperative infections. None of the 17 patients developed postoperative infections. 2. A 53-year-old man undergoing repair of cerebrospinal rhinorrhea in the possibly contaminated area was successfully treated with cefoxitin, given intravenous 2 g every 8 hours for 10 days without meningitis having developed. III. The treatment and prevention of complications 1. A 74-year-old comatose male with a brain stem concussion, who was expectorating insufficiently and had difficulty swallowing and developed into pneumonia as a complication. He was successfully treated with cefoxitin, given intravenous 6 g a day for 2 weeks. 2. A 26-year-old male with a brain stem concussion complicated by pneumonia and a urinary tract infection was successfully treated with the same dose regimen of cefoxitin as the previous patient. 3. The prevention of complications A 58-year-old male with pontine glioma undergoing a tracheotomy was administered cefoxitin for the prevention of pulmonary complication. He died of pontine glioma after the three-month treatment. IV. Side effects Results of skin sensitivity tests given prior to the administration of cefoxitin were negative in all of the 23 patients. Neither anaphylaxis nor other allergic reactions or thrombophlebitis occurred with the intravenous administration of cefoxitin. No abnormalities in blood, hepatic function or renal function were observed. Anorexia occurred in 1 patient who was given cefoxitin, 6 g a day.

Adult↗
PubMed1980

Serum concentrations of C3 and C4 of the complement system in patients with chronic obstructive pulmonary disease.

In a search for host factors for the complex multifactoral disease, chronic obstructive pulmonary disease, we compared some major components of the complement system in 111 subjects with forced expiratory volumes in 1 sec less than 70% of predicted (index subjects) to those in 111 subjects matched as pairs for age, sex, smoking, and occupation having forced expiratory volumes in 1 sec more than 85% of predicted normal. Significantly lower blood levels of C3 and C4 were found in the index subjects (p less than 0.001). Among the index subjects there was a significant correlation between chronic cough and expectoration and low C3 and C4. There was not a significant correlation between low values and the frequency and severity of past respiratory infections. Levels of serum B globulin fraction, in which C3 and C4 migrate, were not different between the index and control subjects.

Complement C3↗
PubMed1980

[Benign endobronchial tumors].

Endobronchial localizations of benign neoplasms are met with in 24.5 per cent of the cases. Right lung localizations are more frequent. More than half of them are broadly based (57.5 per cent). In most of the cases it is a matter of nonepithelial tumours of which a greater intensity is displayed by hamartomas /7/, vascular /4/ and neurogenic /3/ neoformations. The size of endobronchial tumours varies from 1 to 10 cm. Cases measuring 1-3 cm are the most numerous. Those of the "iceberg" type appear to be larger. The size per se has a relative importance for the clinical picture. Endobronchial tumours exhibit a clear cut clinical picture, and run a clinical course in three stages, determined by the degree of bronchial obturation and longstanding of the condition. The most common symptoms are coughing /80.7 per cent/, expectoration /50.0 per cent/, rales /57.6 per cent/, dullness /38.4 per cent/ and lacking respiration /38.4 per cent/. The nosological entity by itself is less conclusive for the clinical course. The X-ray data have orientation and by no means decisive significance for the diagnosis. The "crab pincers" sign in the bronchial lumen during bronchography has a definite importance. Bronchoscopy in conjunction with biopsy is a dependable method of preoperative diagnosing. It contributes greatly to the nosological diagnosis. Even nowadays, the diagnosis of endobronchial tumours is difficult. A rather exact diagnosis can be made intraoperatively, whereas the most accurate diagnosis is established only after histological study. The treatment of endobronchial benign neoplasms is operative. The number of medium /lobectomies/ and extensive /pulmonectomies/ pulmonary resections is considerable. In case of early diagnosis and intervention, sparing resection is the naturally indicated size of operation - mainly resection and plasty of the bronchi without lobectomy. The advantages of circular resection are substantial. Reconstructive operations of "clarinet" and "semilunar" type for the leftside upper lobe do not account for disturbances in its architectonics and impairment of the bronchial-tree draining function, and therefore they may be used more frequently in the routine surgical practice.

Adult↗
PubMed1980

[A new device: the H.R.P.-bronchial-secretions-guard (author's transl)].

Expectoration of bacterially contaminated mucus during bronchial toilet of artificially ventilated patients can be controlled avoiding heavy contamination of intensive care staff, patients and surroundings. By the use of the Bronchial-Secretions-Guard in combination with the H.R.P.-System 2000, the problems of optimal liquidity of bronchial mucus thus avoiding rinsing with saline as well as "bagging" without further devices are solved in regard to bacteriology and hygiene. By the use of this setup a reduction of hospital infections in adult patients of the intensive care unit can be expected in a similar way as reported in a early study on premature and newborn babies ventilated only by the H.R.P.-System 2000.

Adult↗
PubMed1995

[Frequent airway infections].

A 44-year-old patient experienced increasing shortness of breath and cough with yellow expectoration. Physical findings of the patient were not remarkable, whereas x-ray chest examination revealed cicatricial changes of the lower fields of the right lung. Laboratory findings showed a significant reduction of plasma gamma-globulin levels due to a global deficiency of all immunoglobulins. An infectious origin of the immunoglobulin deficiency was not detected. After exclusion of other acquired etiologic conditions, the diagnosis of a variable immunodeficiency syndrome was established. After antibiotic treatment with gyrase-inhibitors, an immunoglobulin-substitution program was initiated. Immediately after the start of an immunoglobulin infusion, the patient developed an allergic reaction. Pretreatment with antihistamine drugs eliminated allergic symptoms. Following immunoglobulin treatment, incidence and severity of infectious diseases were significantly reduced.

Adult↗
PubMed1994

[Atlanto-axial Pott's disease. Apropos of a case with review of the literature].

INTRODUCTION: A new case of sub-occipital Potts disease is reported. CASE REPORT: A 26 years old female from Senegal was admitted for cervical pain of three months duration, neck stiffness and left nasal obstruction with Arnold neuralgia. Radiological studies found a C1-C2 rotatory subluxation with an osteolytic erosion of the lateral mass of the atlas and destruction of the left atlanto-axial joint. CT scan and magnetic resonance imaging provided important diagnostic clues. Culture of sinus biopsies showed a mycobacterium tuberculosis. Progressive reduction of the dislocation and immobilization by minerva jacket for six months with prolonged antituberculous chemotherapy provided successful end result. DISCUSSION: A review of the literature found 95 cases reported since the beginning of this century. The mean age was 20-30 years old. A finding of acid resistant bacilli is necessary for diagnosis and requires culture of gastric secretion, expectoration, retro pharyngeal mass puncture and other upper respiratory tract foci. Radiological signs are discussed. Chemotherapy is the mainstay of treatment with immobilization following reduction of the dislocation when present. The removal of abscess is discussed as well as bone grafting by an anterior or more commonly by posterior approach in case of instability.

Adult↗
PubMed1994

Chloral hydrate sedation: a simple technique.

Chloral hydrate is an oral sedative commonly used in pediatric dentistry when providing extensive treatment in the young child. This article reports the results of a clinical trial using an orally administered dose of chloral hydrate at 75 mg/kg of body weight plus nitrous oxide and oxygen. A method for administering the drug that minimizes initial drug expectoration and vomiting is also presented. Because a reliable method for delivery of chloral hydrate is essential in a study of the ideal effective dose, the authors describe a technique that makes this portion of the treatment process as pleasant as possible by associating the drug with a product known to be pleasing to most children of this age group. The results of the clinical trial of 50 patients revealed that 29 children (58%) slept through the entire procedure and 14 (28%) of the children presented only mild resistance either during anesthesia and/or treatment. If some mild resistance is acceptable to the practitioner then there was an approximately 85% success rate. The authors concluded that chloral hydrate used at a 75 mg/kg dose and supplemented by nitrous oxide/oxygen is a safe and reliably effective sedative for the preschool child.

Anesthesia, Dental↗
PubMed1995

[A case of probable allergic bronchopulmonary aspergillosis due to Aspergillus niger].

We report a case of probable allergic bronchopulmonary aspergillosis (ABPA) due to Aspergillus niger. An 80-year-old woman was admitted to our hospital because of wheezing, expectoration of a mucous plug and atelectasis of the right lower lobe as seen on a chest X-ray film. The patient had eosinophilia and immediate wheal-and-flare skin reactivity to A. fumigatus. Serum precipitating antibodies against A. niger and elevated serum IgE, however, were absent. Mucus impaction and bronchiectasis were revealed by both bronchoscopy and CT scanning. The mucous plug contained A. niger, numerous eosinophils and Charcot-Leyden crystals. Corticosteroid therapy ameliorated the symptoms and abnormal laboratory findings. Therefore, this was a rare, informative case of probable ABPA due to A. niger associated with a normal level of serum IgE and negative precipitation antibodies against A. niger antigen.

Aged↗
PubMed1995

Clinical effectiveness of a combination of bromhexine and amoxicillin in lower respiratory tract infection. A randomized controlled trial.

A multicenter double-blind randomized trial was performed in 22 teaching hospitals to compare the clinical effectiveness of the combination of amoxicillin (CAS 26787-78-0) plus bromhexine (CAS 3572-43-8) versus amoxicillin alone given 4 times a day for 5 to 7 days in the treatment of clinically diagnosed community-acquired bacterial lower respiratory tract infections. 392 adult patients diagnosed clinically to have acute bronchitis or pneumonia of bacterial etiology were recruited for the study with 192 subjects given amoxicillin (250 mg) plus bromhexine (8 mg) (Drug AB) and 200 receiving amoxicillin (250 mg) (Drug AA) alone 4 times a day for 5 to 7 days. Clinical response, improvement in symptom scores using a visual analogue scale, and bacteriologic response were monitored at Days 3, 5 and 7 of treatment. Results showed that although 180/192 (94%) given Drug AB and 185/200 (93%) given Drug AA had favorable clinical response at the end of treatment, the infection was completely resolved for 89/192 (46%) among the Drug AB group and in 67/200 (34%) of patients on Drug AA (p = 0.022). Also, patients given Drug AB had significantly greater reduction of their symptom scores at Day 3 for symptoms of cough discomfort, cough frequency, ease of expectoration and sputum volume. Among the subset of patients with pneumonia, the cure rates for Drug AB and Drug AA were 24/50 (47%) and 11/50 (22%), respectively (p = 0.008). A respiratory pathogen was cultured in only 72/392 (18%) of subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Bronchoesophageal fistula and broncholithiasis].

Bronchoesophageal fistulas (BEF) in an adult, whether acquired or congenital, are uncommon but bronchoesophageal perforation secondary to broncholithiasis caused by calcified mediastinal adenopathy and leading to the formation of a fistulous tract is extremely rare. We present a case of acquired BEF in a 57-years-old women who presented cough with expectoration of broncholiths, hemoptysis and cough after swallowing liquid or solid hemoptysis and cough after swallowing liquid or solid foods. The chest film and computed tomographic scan showed calcified mediastinal adenopathy. Endoscopic examination of the esophagus revealed no mucosal abnormality. A bronchial esophageal fistula was identified at the level of the 1/3 midesophagus just below the carina in the esophagogram. The bronchoscopy showed a polypoid area located in the medial side of the right main bronchus. There was no evidence of neoplasm. The patient underwent excision of fistula and interposition of pleural bundle after completing a right posterolateral thoracotomy. The postoperative course was uneventful and the patient has been doing well on follow-up.

Bronchial Diseases↗
PubMedDate not supplied

Allergic bronchopulmonary aspergillosis: a retrospective study of 35 cases.

Clinical profile of 35 patients with allergic bronchopulmonary aspergillosis (ABPA) was analysed. The disease was found to be more frequent among females. Constitutional symptoms, expectoration, increased breathless and poor control of asthma were the main presenting features. Skin reactivity against aspergillin and Candida was positive in 30 and 2 cases, respectively. Precipitating antibodies against Aspergillus species was positive in 28 cases, and against Candida albicans in 2 cases. Sputum grew either Aspergillus or C. albicans or both in 19 patients. Absolute eosinophilia was observed only in one third of cases. Chest skiagram revealed characteristic central/proximal bronchiectasis and/or fleeting shadows in all cases. No specific pattern was observed on spirometry. There was no correlation between the duration of bronchial asthma, sputum culture and serology results. Most patients responded well to steroids. One striking feature of the study was that one third of the cases were misdiagnosed as pulmonary tuberculosis and were treated with antitubercular drugs for varying periods of time. A high index of clinical suspicion with appropriate laboratory tests are required to identify these cases.

Adolescent↗
PubMed1995

Profuse bleeding in epiphrenic diverticula: an unusual finding.

Profuse bleeding is an unusual and previously unreported finding in epiphrenic diverticula. The present case describes a man with a history of significant alcohol and tobacco abuse who presented to an emergency room expectorating blood and was then admitted. Further evaluation revealed a large bleeding ulcer crater in the distal esophagus. Findings consistent with candida esophagitis were noted on biopsy. Radiographic examination revealed two large, wide-mouthed diverticula. While hypertensive lower esophageal pressure was noted on manometric evaluation, surgery was not performed on the patient, and he subsequently curtailed his alcohol and tobacco intake. A follow-up examination at 90 days' postdischarge revealed no further bleeding episodes with continued decreased alcohol and tobacco intake.

Diaphragm↗
PubMed1976

Double-blind crossover trial of bromhexine (Bisolvon) in the treatment of chronic bronchitis.

The results of a double-blind crossover trial of bromhexine (Bisolvon) in the treatment of chronic bronchitis are reported. Benefit was shown by statistically significant changes in the peak expiratory flow rate, ascultatory findings and sputum volume. Benefit was also demonstrated by changes in dyspnoea, sputum, consistency and ease of expectoration, but these were without statistical significance. A review of the literature together with the results of this trial suggest that, when adequate consideration is given to a number of therapeutic variables, Bisolvon will be effective medication for most patients with chronic bronchitis associated with thick, tenacious sputum.

Adult↗
PubMed1995

[The use of fibrinogen-thrombin via endoscope in the treatment of massive hemoptysis].

We assessed the efficacy of fibrinogen-thrombin instillation through the fiberoptic bronchoscope to treat massive hemoptysis in patients to whom embolization of bronchial arteries was not available, was contraindicated or had failed. The fibrinogen-thrombin solution used was Tissucol, which in addition to 2% fibrinogen and 4 U/ml of thrombin, also contained factor XIII an aprotinin. The fibrinogen-thrombin solution was instilled with the aid of the Duplojec system and a 70 cm x 2 mm 4-way catheter. In 53 of the 628 fiberoptic bronchoscopies performed during the study, the indication was hemoptysis > or = 150 ml/12 h. Of these, bronchoscopic instillation of fibrinogen-thrombin was indicated in 5 cases because bronchial artery embolization was impossible. The point of bleeding was located by bronchoscopy in all cases and fibrinogen-thrombin instillation controlled hemoptysis immediately and throughout the follow-up period, which ranged 4 to 10 months. Morning expectoration of blood (< 10 ml) was observed in only 1 patient in the 3 days after treatment. The mean time taken for bronchoscopic exploration was 3 minutes (range, 2-7). In all cases fiberoptic bronchoscopy was performed without complications that might have required the procedure to be suspended. We conclude that the local use of fibrinogen-thrombin or fibrin glue instilled through the fiberoptic bronchoscope to the point of bleeding is a simple, fast and cheap way to control massive hemoptysis on a short and long-term basis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Clinical bacteriology and empiric therapy for hospital-acquired pneumonia in the elderly at a national leprosarium].

Hospital-acquired pneumonia is one of the most important fatal respiratory diseases in the elderly. Prompt and precise empiric therapy is essential for recovery. Fourteen isolates from twelve elderly lepromatous leprosy patients (9 men, 3 women, mean age of 75.8 years) with hospital-acquired pneumonia were studied. Subsequently, empiric therapy with gentamicin and beta-lactams for nosocomial pneumonia in the elderly was examined. Fourteen types of bacteria isolated from expectorated sputum specimens consisted mainly of ten strains of gram-negative bacilli (71%) six of Klebsiella pneumoniae, one each of Citrobacter freundii, Enterobacter agglomerans, Serratia liquefaciens, and Aeromonas hydrophilia and four strains of gram-positive cocci (29%) two of Staphylococcus sp., one each of Streptococcus sp. and Streptococcus pneumoniae. Methicillin-resistant Staphylococcus aureus and Pseudomonas sp. were not detected. Resistance rates of the etiologic agents to the antibiotics showed that gentamicin was 7.7%, ceftazidime 0%, and cefmetazole 23.1%. Cephalosporins were superior to penicillins. As a result of empiric therapy, six elderly leprosy patients with nosocomial pneumonia were cured and one improved temporarily. This study shows the necessity of specific empiric therapy for hospital-acquired pneumonia in a hospital with many elderly patients. The combination of gentamicin and beta-lactams is of value as an initial antibiotic therapy for hospital-acquired pneumonia in the elderly.

Aged↗