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PubMed1994

[A case of severe pneumonia in an elderly man, caused by Citrobacter freundii suspected to have a low susceptibility to imipenem/cilastatin sodium].

An 80-year-old blind man with lepromatous leprosy suffered from right femoral neck and humeral neck fractures on July 9, 1993. Because of fever (38.6 degrees C), difficult expectoration and diffuse bilateral perihilar infiltrates with consolidation in the left lower lung field on his chest radiograph, severe pneumonia was diagnosed. With intravenous hyperalimentation, imipenem/cilastatin (IPM/CS), ceftazidime, minocycline, gentamicin (GM), and human immunoglobulin were administrated. On July 29, hip screw-plate fixation was done. Citrobacter freundii was isolated from the sputum and its susceptibility was IPM/CS+, GM3+. Multi-drug therapy with GM and other antibiotics improved the patients' condition, but Citrobacter freundii were still detected and 43 days of medication were needed. According to a report by the Ministry of Health and Welfare in 1992, the resistance rate of IPM/CS against Citrobacter freundii is only 0.7%, and IPM/CS is more effective than beta-Lactams. This is a very rare case of severe pneumonia in an elderly patient caused by Citrobacter freundii that was suspected to have low susceptibility to IPM/CS.

Aged↗
PubMed1994

[Respiratory symptoms and function of coal miners presenting radiological pulmonary abnormalities].

Respiratory symptoms and lung function of 80 coal workers suspected of pneumoconiosis (pulmonary X-rays classified 0/1 or 1/0 according to International Labour Organisation classification) who worked for at least 10 years at face work (Ts) were studied in comparison with two control groups matched by age (+/- 2 years), height (+/- 5 cm), weight (+/- 10 kg) and smoking habits: the Tn group constituted by 80 coal workers who worked for at least 10 years at face work with normal pulmonary X-rays, and the HTn group constituted by 80 underground miners who worked mainly out of face work with normal pulmonary X-rays. The frequencies of cough, expectoration, chronic bronchitis or dyspnoea were significantly higher in Ts group than in the two others. The one-second forced expiratory volume to vital capacity ratio (FEV1/VC) was lower, closing volume to vital capacity (CV/VC) or to total lung capacity ratios (CV/TLC) were higher in Ts group than in the control groups. Unexpectedly, vital capacity (VC), one-second forced expiratory volume (FEV1), total lung capacity (TLC), compliance, diffusing capacity (DLCO) referred to alveolar volume (VA) were higher. In Ts group, the small rounded opacities were noted in the top part of the lung (56.9%), the irregular ones were distributed on the entire lung (65.5%). There were no relation between the category of small opacities and respiratory symptoms or lung function.

Adult↗
PubMed1976

Effect of bromhexine and guaiphenesine on clinical state, ventilatory capacity and sputum viscosity in chronic asthma.

Thirty-four patients, 21 male and 13 female, with chronic asthma and tenacious mucoid expectoration were studied regarding clinical parameters, PEF, airway resistance and sputum viscosity measured according to the n.m.r. method (nuclear magnetic resonance); a technique for determination of the water phase viscosity. Using double-blind cross-over technique, oral treatment with the two drugs and placebo was given during three consecutive 12-day periods with 48-h intervals free of test drug. No significant improvement in clinical state, PEF or airway resistance could be demonstrated. Nor did the sputum viscosity show any significant change after treatment with the different preparations. However, regarding the patients' own preference of drug as to mucolytic effect, a significant difference in favour of bromhexine at the 0.1% level was shown.

Airway Resistance↗
PubMed1994

Hypereosinophilia in association with pulmonary tuberculosis in a rural population in south India.

In a prospective study conducted in four villages of North Arcot Ambedkar district of Tamil Nadu in south India over a 5 yr period from 1981-86, 279 patients were detected to have pulmonary tuberculosis (PTB). Thirty one of them were found to have associated hypereosinophilia (HE) with total blood eosinophil level of > or = 2000 per cumm; besides cough with expectoration they also complained of dyspnoea and wheeze. Twelve of the 18 patients with intestinal parasites had remission with deworming agents alone. The other 6 non responsive patients like the 13 who did not have parasitic infestation, needed treatment with diethylcarbamazine for eosinopenic remission and thus could be classified as patients of tropical pulmonary eosinophilia (TPE). The association of hypereosinopilic state as a whole as well as TPE with tuberculosis as compared to that prevalent in the general population was found to be highly significant (P < 0.001). The frequent association of TPE with tuberculosis as observed by us suggests the possibility of an early hypersensitivity reaction to mycobacterial antigens triggering a florid TPE state in susceptible patients from an area endemic for filariasis. A similar mechanism may also operate in cases of pulmonary eosinophilia induced by other helminths in areas where they are endemic.

Adolescent↗
PubMed1994

[Treatment of community-acquired pneumonia by pristinamycin (Pyostacine 500). Results of a non comparative open study].

UNLABELLED: Activity of natural streptogramin (NSG) appears well adapted to pathogens responsible for CAP. The goal of this multicenter pilot study was to bring first data about efficacy of NSG in treatment of CAP. PATIENTS METHOD: Ten days of a NSG (1 gr b.i.d. or t.i.d.) regimen was administered to 46 hospitalized adult patients for CAP defined with fever > 38 degrees C, respiratory symptoms and X-ray opacity. Severely ill patients were excluded. A broncho-pulmonar sample (expectoration or trantracheal aspiration or protected distal sample) was performed in all patients. RESULTS: two patients were excluded because of pulmonary embolism (n = 1) or tuberculosis (n = 1) and 44 patients were analyzed. 50% of them had associated disease, 20% had failure of prior antibiotherapy. At inclusion, mean fever was 39.2 +/- 0.7 degrees C, respiratory rate was 22 +/- 5/mn, PaO2 was 74 +/- 10 mmHg, chest X-ray showed bilateral opacity in 16%, unilateral in 84% and pleural fluid level in 6 cases. Etiological diagnosis was determined in 70% of cases. Streptococcus pneumoniae (n = 14), Haemophilus influenzae (n = 5), Legionella pneumophila (n = 2), Mycoplasma pneumoniae (n = 2) and Chlamydia psittaci (n = 1) were the most frequent isolated pathogens. 40 patients (91%) were cured with NSG and delay to obtain apyrexia was 4.4 +/- 3.9 days. NSG was stopped in 4 patients: 1 clinical and bacteriological failure (Klebsiella pneumoniae), 2 clinical failures (1 pneumococcus with purulent pleurisy, 1 pneumococcus with worsening of respiratory status), 1 patient with resistant H. influenzae strain in spite of favourable clinical evolution. NSG was well tolerated in 86% of patients. CONCLUSION: these data invite to carry on evaluation of first line therapy of CAP with NSG.

Adult↗
PubMedDate not supplied

Salmonella group-E (Senftenberg) lung abscess: a case report.

A male patient presented with complaints of fever, cough with expectoration, burning micturition and 5-6 semisolid motions per day for the past 6 days. Skiagram chest (PA view) revealed lung abscess in the left mid zone. There was no improvement, symptomatically and radiologically, after an empirical course of antibiotics (IV ampicillin and gentamycin). Sputum, urine and stool cultures grew salmonella group E organisms sensitive only to cefotaxime. The patient was treated with IV cefotaxime and responded well clinically, radiologically and bacteriologically.

Cefotaxime↗
PubMed1994

Evaluation of the efficacy of pidotimod in the exacerbations in patients affected with chronic bronchitis.

The efficacy and safety of pidotimod ((R)-3-[(S)-(5-oxo-2-pyrrolidinyl)carbonyl]-thiazolidine-4-carboxylic acid, PGT/1A, CAS 121808-62-6), a new oral synthetic immunostimulating agent, were investigated in a multicentre study, performed in 10 university and hospital centres of pneumophthisiology and respiratory physiopathology, according to a double-blind vs. placebo experimental design. Primary objective of the investigation was to verify the efficacy of pidotimod against infectious exacerbations in patients affected with chronic bronchitis. 181 inpatients or outpatients (117 male, 64 female; mean age: 62.5 years), affected with chronic bronchitis, were enrolled in the study. Pidotimod 800 mg/die or placebo sachets were administered by oral route for 60 consecutive days, followed by a 60-day follow-up period. Clinical observations were performed at baseline (D 0), after 30 (D 30) and 60 (D 60) days of treatment, as well as at the end of the follow-up (D 120). Time and frequency of infectious relapses were considered as the target variable for the evaluation of the efficacy of the drug. Clinical picture, expectoration characteristics, spirometric parameters and laboratory tests were monitored to evaluate patients' conditions. The results indicate that pidotimod is significantly more effective than placebo against infectious relapses in patients suffering from chronic bronchitis. During the first month, 9% of patients treated with pidotimod were affected with an infectious relapse vs. 39.5% of patients treated with placebo (chi 2, p < 0.001). In the second month, infectious episodes were reported by 1.2% of patients treated with the drug vs. 46.1% of patients treated with placebo (chi 2, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[A tracheal prosthesis made from P(AEMA)--a further step toward tracheal replacement].

In animal experiments (5 dogs) the authors tested a material for the construction of tracheal prostheses so far not used in other countries. P(AEMA), the polymer 2-acetoxy-ethylmethacrylate is well tolerated, it did not produce a rejection reaction. The inner wall of the prosthesis was throughout the experiment patent, smooth and secretion did not adhere to it. Macroscopic examination did not reveal cumulation of mucus and signs of infection. The self-cleansing capacity was not impaired and the dog was able to expectorate mucus over a 5 cm length of the prosthesis. The solid ends of the prosthesis, however, caused mechanical irritation of the site of anastomosis and after cca 4 weeks of the experiment granulation tissue began to form. The experiments were terminated on account of complete occlusion of the lumen of the airways by granulation tissue 4-6 weeks after operation. The authors' efforts to design a suitable tracheal prosthesis led to a change of strategy of subsequent research. They started experiments with a heterologous portion of the pig trachea devoid of antigenicity; this will be the subject of a subsequent paper.

Animals↗
PubMed1994

[Clinical features and morbidity of group B diffuse interstitial pneumonia, atypical subtype, compared with group A, typical idiopathic subtype].

Diffuse interstitial pneumonia of unknown etiology has been subclassified into two groups on the patho-histological basis by the study group under the sponsorship of the Japanese Ministry of Health and Welfare. One is Group A, typical idiopathic subtype, fundamentally corresponding to UIP (usual interstitial pneumonia, Liebow) and the other is Group B, closely similar to Group A but possibly modified by respiratory infection. As the clinical features of Group B have not been clarified so far, we investigated them in 8 cases of Group B (M:F = 7:1, 56.7 years at first visit) and 5 cases of Group A (M:F = 4:1, 54.4 years), all of which were pathologically diagnosed by open lung biopsy and/or autopsy. Only in Group B, there were 3 cases with occupations related to dust exposure, and 7 cases with intermittent but persistent mucus expectoration. The duration of symptoms before the first presentation to hospital was longer in Group B than in Group A (1.6 years vs. 0.6 years). Clubbed fingers were more frequently observed in Group B (n = 6 vs. n = 1), but induration in the tuberculin test was less frequent in Group B (n = 1 vs. n = 5). In the chest X-ray findings, pleural thickening was frequent in Group B (n = 6 vs. n = 0), but elevation of the diaphragm was unusual in Group B (n = 2 vs. n = 5).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Pathogenesis of chronic bronchitis.

Inflammation of the central airways is a prominent feature in subjects with chronic bronchitis. The pathology of chronic bronchitis includes an inflammatory mononuclear cell infiltrate in the airway wall and a neutrophil influx into the airway lumen. The molecular events that produce the inflammation and its pathogenetic role in causing mucus hypersecretion are beginning to be elucidated. The inflammatory cell recruitment to the airways likely involves chemotactic agents derived not only from tissue fluid and invading microbes but also generated by the diseased bronchial epithelium. For example, bronchial epithelial cells synthesize interleukin (IL-8), a potent chemoattractant and activator of neutrophils and lymphocytes. Adhesion of infiltrating leukocytes to resident parenchymal cells in the bronchi and to extracellular matrix also is crucial for the development of airway inflammation. The resultant inflammation likely plays a direct role in the clinical features of the disorder. There is growing evidence incriminating neutrophil and lymphocytes constituents in the initiation and maintenance of cough and mucus expectoration that occurs in subjects with chronic bronchitis.

Bronchitis↗
PubMed1994

[Clinical microbiological study of sputum and aspirates from larynx or trachea. An evaluation of exact criteria for assessment by direct microscopy].

A prospective study of specimens of lower airway secretions was carried out in order to investigate the association of specimen quality and results of microbiological culture. The quality of expectorates (EXP) or aspirates from larynx/trachea (ALT) was assessed on the basis of numbers per low power field (< 1, 1-10, 11-25, and > 25) of squamous epithelial cells (SEC) and leukocytes, respectively. Specimens were classified as either acceptable, A (< or = 10 SEC), partly acceptable, B (11-25 SEC, > 25 leukocytes), or not acceptable, C (the remaining specimens). Six hundred and six specimens (385 EXP, 221 ALT) from 408 patients were included, and the distribution among categories was A 373 (62%), B 88 (15%), and C 144 (24%). For isolates of Streptococcus pneumoniae (n = 42) and Haemophilus influenzae (n = 51) there was a statistically significant association with specimen quality, and for aerobic bacteria including Pseudomonas aeruginosa a trend was noted. However, isolates of Enterobacteriaceae (n = 105), Staphylococcus aureus (n = 61), yeasts (n = 45) and Branhamella catarrhalis (n = 7) were not associated with specimen quality. It is concluded that a defined set of criteria allows a useful classification of EXP and ALT by direct microscopy and that it is justifiable not to cultivate specimens found not to be acceptable (category C).

Humans↗
PubMedDate not supplied

An outbreak of infectious laryngotracheitis in California broilers.

Infectious laryngotracheitis (ILT) was diagnosed as the cause of an outbreak of respiratory disease in broiler chickens in California. The classical form of ILT is characterized by dyspnea, gasping, coughing, and expectoration of bloody exudate. Most of the broilers submitted to the diagnostic laboratory showed a non-classical presentation of ILT, in which mucoid tracheitis and conjunctivitis were the most consistent lesions. Historically, most of the ILT cases diagnosed in our laboratory have consisted of layers with classical signs and lesions. It is not known whether this non classical presentation of ILT in broilers is due to differences in the way broilers respond to ILT infection or to the nature of the ILT virus isolate.

Animals↗
PubMed1994

[Diagnosis of chronic obstructive bronchitis].

Cough and mucociliary clearances were investigated in patients with chronic obstructive bronchitis, chronic bronchitis, chronic nonobstructive bronchitis by ciliary activity of the ciliated epithelium and cough intensity according to the formulas, using inulin and tussographic techniques of expectoration testing. The findings above were compared to clinical manifestations of bronchitis, x-ray pictures, bronchial mucosa bronchoscopy and cytology, examination of external respiration. The analysis of the data obtained provided the conclusion that early diagnosis of chronic obstructive bronchitis is valid in ciliary activity of the ciliated epithelium equal or surpassing 1 and cough intensity under 35%.

Adolescent↗
PubMed1994

[Visceral form of human anthrax imported from Africa].

Widespread vaccination has largely eliminated anthrax in Europe (the last case was reported in France in 1972) but the disease remains endemic in many developing countries. The usual cutaneous presentation (malignant pustules) is much more familiar than the various visceral manifestations including digestive tract, pulmonary or meningeal signs. We report a case of a 33-year-old immigrant living in France who was hospitalized for asthenia, dyspnoea, mucopurulant expectoration and moderate diarrhoea 3 days after a 3-month stay in Senegal and Gambia. The temperature was 39 degrees C at admission and blood pressure 110/70 mmHg. Crepitants were heard at the base of the right lung and the rest of the physical examination was normal. Blood was drawn for culture. Laboratory tests and the chest X-ray led to the diagnosis of pneumopathy and a treatment of amoxicillin and clavulanic acid was given with oxygenotherapy. The patient's temperature returned to normal but over the next 48 hours the dyspnoea worsened together with the black diarrhoea. The abdomen was painful. There were no skin lesions. The chest X-ray revealed an extension of the bilateral pulmonary images and bilateral pleural effusion. Laboratory tests revealed thrombopenia (platelet count 38,000/mm3) hyperleukocytosis (WBC 48,000/mm3) and haemolysis (Hb 4 milligrams). The diagnosis was made on the basis of the initial blood cultures which were positive for Bacillus anthracis. All other samples were negative, including HIV serology. Despite adapted antibiotic therapy (penicillin G, 8MU/day, was initiated on day 2), multiple organ failure occurred with septic shock and pulmonary oedema. The patient died in the intensive care unit on day 7. Fatal outcome due to anthrax is described in 25% of the visceral forms but reaches 100% in cases of septicaemia. The haemolysis observed in this case is not mentioned in the classical descriptions of anthrax. When treating septic syndromes in patients who have returned from endemic zones, clinicians should entertain the diagnosis of anthrax since the risk of fatal outcome is increased greatly in case of delayed diagnosis.

Adult↗
PubMed1994

Measurement of respiratory impedance by forced oscillation: comparison of the standard and head generator methods.

Physiological and clinical studies have shown that the standard method of measuring respiratory impedance by forced oscillation leads to less efficient control of the upper airway shunt effect than the head generator method. To test the effects of these two techniques in epidemiological studies, we compared, in a sample of 73 French agricultural workers, the values obtained with each method for five forced oscillation parameters: resistance, frequency dependence of resistance, inertance, compliance and resonant frequency. For these comparisons, subjects were classified according to four respiratory status factors: smoking status, cough, expectoration and airway obstruction assessed from the maximum expiratory flow volume curve. Logistic regression models using the set of four forced oscillation parameters (excluding resonant frequency, which is derived from compliance and inertance) were then used to analyse the ability of each method to classify the subjects in each group. Significant differences between the two methods were observed for the mean values obtained for all five parameters. However, when each parameter was considered separately, the correlations between the values for each method were significant. Each method possessed the necessary ability to separate subjects into our group classification, but the significant relationships were not always found for the same parameters. Finally, logistic regression models showed that the two methods led to almost the same classification of the subjects. According to our results, the standard method of applying forced oscillation at the mouth seems an acceptable device for measuring respiratory impedance for epidemiological purposes.

Airway Obstruction↗
PubMed1994

[Infrequent clinical presentation of Askin's tumor].

Malign small cell tumors in the thoracopulmonary region is a tumor of neuroectodermic origins with polymorphous and infrequent presentation. It is mostly found among young people, developing an aggressive and severe course. It is a small cell tumor involving small quantities of cytoplasm without glucogen, round or oval nucleus with disperse chromatin, and little prominent nucleolus without tendency of manifesting pseudo red spots, being PAS negative. Two cases which initially resembled pleuropulmonary infection are presented. Case 1: Sixteen year old male. Presented with a high fever, pleuritic thoracic pain, and a cough with little expectoration. He was diagnosed with severe pulmonary infection and parapneumonic right pleural discharge. His condition improved with antibiotic treatment, but the cough persisted. Thoracoabdominal echography showed right pleural discharge and possible hepatic mass. Surgical intervention was performed. Askin's tumor was detected by biopsy. He began treatment with chemotherapy. Case 2: Thirty-four year old woman. Presented with non-productive cough, pleuritic thoracic pain, and high fever. In the thoracic TAC, there was right pleural discharge along with images suggesting hypodense mass. Given the patient's lack of response to antibiotics, a thoracotomy was performed. The anatomopathological diagnosis was Atkin's tumor. After beginning treatment, the patient died after ten days.

Adolescent↗
PubMed1993

[The clinico-diagnostic significance of qualitative cough indices in nonspecific lung diseases].

It is proposed to make a qualitative analysis of one of the most frequent bronchopulmonary symptoms--cough. This involves dynamic tussographic evaluation of the cough and expectoration in the original inulin test. The analysis covered such cough characteristics as resistance, efficacy, intensity, volleys assessed in patients with lung cancer, chronic bronchitis, tracheobronchial dyskinesia. Typical changes in the above indices observed in each of the patient groups have been defined which are essential for diagnosis and differential diagnosis.

Bronchitis↗
PubMedDate not supplied

[Respiratory symptoms and spirometric tests of quarry workers in Rio de Janeiro].

Respiratory symptoms and past history of chest disease as well as spirometric tests were investigated in 72 of 86 (83.7%) employees of a middle sized quarry in Rio de Janeiro, Brazil. Seventy one were men (98.6%), and the mean age was 36.2 +/- 9.3 years (20-65). Forty two (58.3%) had occupations considered as highly exposed to dust, and 30 (44.7%) were considered as lightly exposed. Forty (55.6%) were smokers, 20 (27.8%) never had been smokers and 12 (16.7%) were former smokers. Symptoms and past history were investigated with a questionnaire based on international models, and adapted for the Brazilian public. A high prevalence of symptoms (except for dyspnea) was noted: 47 (65.3%) had one or more symptoms-there was cough in 31.9%, expectoration in 41.7% dyspnea in 9.7% and wheezing in 33.3%. The symptoms were found to be associated mostly with a past history of chest disease, and also with smoking, factors which explained, in part, the presence of the symptoms. No association with a higher exposure to dust was found. The exposure to dust did not explain the symptoms. The spirometric tests were performed on a 6 liter bell spirometer. The means of the parameters were lower than one would expect in a non selected population sample--89.9 +/- 11.2% of predicted for the Forced Vital Capacity (FVC), 90.1 +/- 12.9% for the Forced Expiratory Volume in 1 second (FEV1) and 92.9 +/- 32.7% for the Forced Expiratory Flow between 25% and 75% of the FVC (FEF25-75). However, the proportions of abnormal results were comparable to the reported ones from unselected samples. There was no statistically significant influence of higher dust exposure, past history or smoking on the means of the results. It is concluded that, in this sample of quarry employees, no association between respiratory symptoms or spirometric results and dust exposure could be demonstrated. There was an association between the symptoms, but not with the spirometric results, and a past history of chest disease, as well as with smoking.

Adult↗