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PubMed1993

Cardiac myxoma.

Thirty-five patients (10 men and 25 women) with a preoperative diagnosis of cardiac myxoma have undergone cardiac surgery since 1964 at the University of Louvain. The mean age of the patients was 49 (range 20-75) years. The most commonly encountered symptoms were: dyspnoea 49%; thoracic pain 26%; cough and peripheral embolism 17% each; stroke and preoperative atrial fibrillation 14% each; flutter 11%; expectoration, acute pulmonary oedema, syncope and transient ischaemic attack 6% each; and pulmonary embolism 3%. The different locations were: left atrium 66%; right atrium 26%; both atria 3%; right ventricle 3%: and retrohepatic vena cavae 3%. Septal implantation was found in 66%. Histological examination confirmed 28 myxomas but three 'tumours' were thrombi, two haemangiomas, one rhabdomyosarcoma and one liposarcoma. The follow-up has now reached 2829 months with an average of 81 months per patient (range 0-342 months). Three patients died early (9%) and there were four late deaths (11%). No cases were familial. Surgical resection is the correct treatment for cardiac myxomas and gives good long-term results.

Adult↗
PubMedDate not supplied

The Flutter VRP1: a new personal pocket therapeutic device used as an adjunct to drug therapy in the management of bronchial asthma.

Respiratory physiotherapy is essential to the treatment of all acute or chronic respiratory disorders in which expectoration difficulties are a major problem. A new personal pocket therapeutic device that looks like a small pipe, the Flutter VRP1, combines safe endobronchial positive expiratory pressure, varying between 10 and 20 cm of water, with oscillations of both the intrabronchial pressure and the flow of exhaled air. We have tested this device in 20 patients (12 males and 8 females) suffering from hyperproductive asthma, presenting in common, among other factors, hypersensitivity to acarids as a major allergen. Patients used the device a minimum of 5 x 5 min daily for 30-45 days as the sole physiotherapy and did not take any mucolytics during the study period. The forced expiratory volume in one second (FEV1), the vital capacity (VC) and the peak expiratory flow (PEF) were measured immediately before and after 1 month of treatment with the Flutter VRP1. All three parameters were significantly improved by the daily use of this therapeutic device. Both objective and subjective improvement was evidenced in 18 of 20 patients.

Adult↗
PubMed1993

[Community-acquired pneumonia].

Pneumonias are inflammatory diseases of the lung parenchyma, infection is one of possible causes. With regard to the causes of community acquired pneumonias it is possible to distinguish those typical ones (caused by pneumococcus, legionella and other bacteria) and atypical ones (caused by mycoplasma, chlamydiae and others). Contrary to the atypical ones, typical pneumonias are characterized by sudden onset, high fever, chills, sometimes bloody expectoration and pains, as well as segmental or lobar changes and high leukocyte counts. Patients with tachycardia, diastolic blood pressure below 60 mm Hg and a blood urea nitrogen (BUN) of more than 7 mmol/l, as well as those with chronic basic diseases and a severe course should be hospitalized, further also those, who do not improve after 2 or 3 days therapy, in all cases of suspected pneumonia, with smokers and with patients aged over 40 years, a thorax X-ray should be executed. Typical pneumonias should be treated with penicillin or macrolide antibiotics, atypical ones with macrolide antibiotics, pneumonias with severe course additionally with a second generation cephalosporin. Where these simple rules are observed, a reduction of the still high mortality due to externally acquired pneumonias might be expected.

Adult↗
PubMed1994

[Bronchial hyperreactivity and obstructive respiratory tract diseases. A 2.8 year follow-up study].

BACKGROUND: Nonspecific bronchial hyperreactivity (BHR) is under discussion as a possible risk factor for the development of chronic obstructive pulmonary disease. METHOD: Within the framework of a prospective study, we investigated the course of the disease in 50 inpatients with BHR, and the clinical symptoms of airways disease (coughing, dyspnea and expectoration) with no manifest airways obstruction at rest (Rt < 3.5 cm H2O/l/s) on admission to the hospital. The unspecific inhalative provocation challenge was carried out with metacholine. The presence of BHR was assumed when the resting respiratory resistance (Rt) of < 3.5 cm H2O/l/s increased to more than 6 cm H2O/l/s. On admission to hospital, all the patients were treated with inhalative bronchodilators and glucocorticosteroids. RESULTS: After an average period of 2.8 years, BHR was no longer measurable in only 7 of the patients (14%), while 28 patients (56%) continued to have a BHR with clinical symptomatology presenting. In 15 patients (30%), manifest airways obstruction at rest, with an average Rt of 6.4 cm H2O/l/s developed. In patients with an uncharacteristic cough, dyspnea and unremarkable lung function parameters at rest, a provocation test should be done to identify BHR. A prognosis can, however, not be established on the basis of a single demonstration of BHR, but only after observation over a longer period.

Adult↗
PubMed1994

[Experience with rocephin in orthopedic practice].

Authors report on the results of Rocephin prophylaxis in 30 total prostheses. The dose of the preparation was 2g/day. It was given 3 times in intravenous drop infusion 1-1.5 hours before the operation and on the second and third day. The drains were then removed. During 1 year observation no wound infection was observed. As a postoperative complication exacerbation of chronic bronchitis, existing already since years, was found. This however healed after 5 and 6 days of Rocephin and expectorant treatment. As side effect of the medicament, in single cases, vomiting, stomatitis, thrombocytopenia and allergic dermatitis were observed. It is stated, based on own experience, that the broad spectrum Rocephin, belonging to the third generation cephalosporins, securing a 24 hours bactericide activity, is suitable in a single 2g dose/day in hip endoprosthesis to prevent postoperative infections.

Aged↗
PubMed1994

[Use of bronchoalveolar lavage in the diagnosis of pulmonary complications in immunocompromised patients].

The authors examined, using bronchoalveolar lavage, 70 immunocompromised patients with pulmonary complications. The bronchoalveolar fluid was subjected to cytological and microbiological examination. The examination was not associated with any serious undesirable side effects, not even in patients who were in a serious general condition. Based on the examination the treatment was changed in 83% of the patients and the correctness of treatment was confirmed in 7% of the patients. In 76% of the patients the condition improved. It was possible for instance to diagnose pneumonia caused by Pneumocystic carinii, the Herpes simplex virus and fungi even in patients who did not expectorate sputum. The authors hold the view that this examination should be indicated early.

Adolescent↗
PubMed1975

[Ventilation aerosol therapy (author's transl)].

Ventilation aerosol therapy (a combination of intermittent positive pressure artificial respiration with aerosol therapy) produces a mechanical support for the breathing, achieves an effective aerosol action and promotes expectoration. It makes possible an effective treatment of inflammatory and obstructive bronchopulmonary diseases. The expense of apparatus and personnel for this method of treatment can only become rational and more economical for the large number of outpatients and hospitalized patients by taking advantage of a special department. The functional areas of such a ventilation aerosol department should be: outpatient department for artificial respiration, bedside artificial respiration and aerosol, ward for ventilation aerosol therapy and ventilation aerosol therapy under supervision and intensive care.

Aerosols↗
PubMed1993

Efficacy and tolerability of brodimoprim in respiratory tract infections.

Brodimoprim is a new diaminopyridine derivative suitable for oral therapy which shows good in-vitro activity against most Gram-positive and Gram-negative pathogens. The efficacy and tolerability of brodimoprim in acute lower respiratory tract infections was tested in controlled clinical trials in comparison with different classes of antibiotics. Acute bacterial infections or infective exacerbations of chronic obstructive bronchitis were included in the studies. Brodimoprim in a single dose was compared to different oral treatments which included co-trimoxazole (trimethoprim 160 mg+sulphamethoxazole 800 mg every 12 hours) and erythromycin (600 mg three times a day). In the studies criteria of efficacy such as daily temperature curve, intensity and frequency of cough, degree of dyspnea, intensity of thoracic pain, difficulty of expectoration, sputum production, thoracic semiology were examined. Brodimoprim was more effective than cotrimoxazole and erythromycin at the end of the treatment, induring a more significant and prompt reduction of axillary temperature, daily sputum volume, degree of dyspnea. There was no difference among treatments in the mean period of therapy to obtain the resolution of the infective process (8 days on average). Brodimoprim had a significantly lower percentage of side effects during the treatment in comparison with cotrimoxazole or erythromycin. Hence brodimoprim was better accepted by patients.

Adult↗
PubMed1976

[Iodine-induced hypothyroidism (author's transl)].

Excessive administration of iodine over a long period may cause hypothyroidism in suitably disposed individuals and provoke the formation of a goiter. The underlying reason for this is the pathological lack of adaptation of the thyroid gland to high doses of iodine with persisting inhibition of hormone production through excess of intracellular iodine (Wolff-Chaikoff effect). Asthmatic patients--as in the case described - are usually affected, when they have taken iodine-containing expectorants over a long time. Provocation of an iodine-induced hypothyroidism by the recently required iodine prophylaxis of endemic goiter is not to be expected because the quantities of iodine lie within the physiological range.

Asthma↗
PubMed1993

[Reliability of ambulatory drug therapy in childhood].

The continuing increase in outpatient paediatric treatments requires parents to take more responsibility for the drug therapy prescribed. Randomly selected mothers were given questionnaires, to be filled in anonymously, about the administration of drugs frequently prescribed for their children. The evaluation of 888 questionnaires showed that only one-half of the prescribed drugs had been administered according to instruction: Expectorants and antitussive sedatives to 52%, externals to 57%, rhinological agents to 36% and laryngological drugs to 27%. With antibiotics, however, the compliance was higher. In order to improve compliance, the mutual relationship: doctor-mother-child-drug, should be reconsidered.

Ambulatory Care↗
PubMed1976

Mistabron in the intensive care unit.

Mistabron is the trade-name of a new mucolytic agent, that has certain advantages over older mucolytic agents. This drug has been used to a great extent in patients with tracheobronchial secretions in the department of intensive care medicine. Its application makes expectoration easier while its preventive administration diminishes greatly the incidence of lung complications.

Humans↗
PubMed1993

[Analysis of differential cell counts of sputa induced by inhalation of ultrasonically nebulized hypertonic saline or distilled water in asthmatic patients].

Bronchial asthma is an inflammatory disease of the airways, and a simple method of evaluating inflammation, safer than BALF or bronchial mucosal biopsy, has long been sought after. The induction of sputa by the inhalation of an appropriate solution and the examination of the induced sputa may provide such a method. We compared the safety of two sputum induction methods, ultrasonically nebulized hypertonic saline inhalation and distilled water inhalation, and examined the usefulness of differential cell counts of the induced sputa. The safety of these methods was ascertained by determining lung functions (FEV1.0, PEFR) and urinary leukotriene E4 before and after inhalation of these solutions, and the usefulness of differential cell counts of induced sputa by examining the uniformity/reproducibility. Only after the inhalation of distilled water did the lung function reveal a statistically significant decrease when the data were compared with the control values for each of the two methods (p < 0.01), and when the data obtained with distilled water inhalation and hypertonic saline inhalation were compared (p < 0.05). The urinary leukotriene E4 levels obtained were not very different between the two methods; however, in two patients, urinary leukotriene E4 levels were increased markedly only after inhalation of distilled water. The uniformity of the sputum differential cell counts in the same specimen (evaluated by intraclass correlation coefficient) and inter-specimens (evaluated by Friedman test) was satisfactory for both methods, except for basophils. Hypertonic saline inhalation at 24-hour intervals gave a better reproducibility in differential cell counts of the induced sputa (evaluated by interclass correlation coefficient), when compared with distilled water inhalation. These results suggest that hypertonic saline inhalation is safer and more useful than distilled water inhalation for induction of sputum in a uniform and reproducible way, and that the induction of sputum by hypertonic saline inhalation will be clinically useful in asthmatic patients who cannot expectorate sputa spontaneously.

Administration, Inhalation↗
PubMed1993

[Current aspects in diagnosis of chronic cor pulmonale].

Pulmonary hypertension occurs frequently in patients with chronic obstructive lung diseases and contributes to a poor prognosis. Most common symptoms in addition to dyspnea, cough and expectoration are fatigue, syncopes, chest pain and peripheral oedema. No single non-invasive method such as lung function testing, blood gas analysis, ECG, chest x-ray, myocardial scintigraphy and isotopic radionuclide ventriculography is sufficiently reliable for predicting pulmonary hypertension. Only the combination leads to the diagnosis of pulmonary hypertension and cor pulmonale within acceptable limits. Echocardiography was found to be a reliable method of assessing right ventricular function. Doppler echocardiography is most useful with a specificity and sensitivity of about 80%. As "golden standard" cardiac catheterisation is still required for the measurement of pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), cardiac output (CO) and pulmonary capillary wedge pressure (PCWP) at rest and exercise.

Cardiac Catheterization↗
PubMed1993

[Monotherapy using amoxicillin/clavulanic acid as treatment of first choice in community-acquired lung abscess. Apropos of 57 cases].

In a multicentre open prospective trial the effectiveness of AM-CA as first-line treatment of community-acquired lung abscess was evaluated in immunocompetent adult patients. AM-CA was administered intravenously in doses of 4 g/day for at least 7 days, then orally in doses of 2 g/day for at least 14 days. Radio-clinical and laboratory evaluations were made during treatment, and 30 and 60 days after it was discontinued. The results of this trial concerned 57 patients (48 men, 9 women; mean age 52 years). The facilitating factors were those usually found in lung abscess. Twenty-seven patients had previously received an antibiotic treatment which had failed. The clinical picture, built up gradually in 42/37 patients, consisted of infectious syndrome (52 cases), altered general condition (39 cases), purulent expectoration (47 cases), sometimes foetid (10 cases), and thoracic clinical abnormalities (57 cases. X-ray films of the chest showed round abscess images (44 cases) or looked like necrotizing pneumonia (13 cases) with pleural reaction (8 cases). Protecting bacteriological sampling by BFW brushing and transtracheal or transparietal sample collecting was performed in 41 of the 57 patients. The pathogens, isolated in 31 cases, were: S. pneumoniae 5; Streptococcus spp. 12; Staph. aureus 4; H. influenzae 7; Enterobacteriaceae 6; anaerobes 7. These organisms were associated in 8 cases. With the exception of Enterobacter cloacae, all were sensitive to AM-CA in-vitro. The outcome was satisfactory in 52 patients.

Adolescent↗
PubMed1994

Early identification and isolation of inpatients at high risk for tuberculosis.

BACKGROUND: Although it has been recommended that all patients suspected of having tuberculosis be placed in isolation, the feasibility of this recommendation has not been investigated. METHODS: Forty-three patients with pulmonary tuberculosis were compared with 43 control subjects. The control subjects had submitted expectorated sputum, and were culture negative. Variables included chest roentgenogram results, and risk factors used by the Centers for Disease Control and Prevention (Atlanta, Ga) to identify patients at increased risk for tuberculosis. RESULTS: Potential control subjects outnumbered patients by 92:1. Although a positive tuberculin skin test, foreign birth, and weight loss were more common in the patients, 86% of the control subjects had at least one risk factor for tuberculosis. Chest roentgenograms consistent with tuberculosis (cavities or apical or nodular infiltrates) were found in 86% of the patients, but in only 16% of the control subjects (odds ratio, 31.7; 95% confidence interval, 8.6 to 127.7). The positive and negative predictive values of a consistent chest roentgenogram were 6% and 99.8%, respectively. The sensitivity of testing a single sputum specimen was 81%, yet almost half of the control subjects had only one specimen submitted. Of the inpatient cases, 58% were not identified on admission with a median delay of 13 days before isolation. CONCLUSIONS: Isolating all the patients at the time sputum is submitted for testing is not practical and would have resulted in a 92-fold overuse of isolation rooms. The chest roentgenogram was of great value in identifying patients who did not require isolation and was the best available means of identifying inpatients at high risk for active pulmonary tuberculosis.

Adult↗
PubMed1993

[Results of initial bacteriology of pulmonary tuberculosis among male NTT employees in the Tokyo area--annual transition and influence of fiberoptic bronchoscopy].

A study was made on the annual changes in the positive rate for acid-fast bacilli (AFB) at the initial bacteriological examination of newly detected pulmonary tuberculosis among male NTT (Nippon Telegraph and Telephone Corporation) employees in the Tokyo area during a period of 32 years from 1960 through 1991. The influence on the changes of recent introduction of fiberoptic bronchoscopy for obtaining the specimen was also analyzed, and the following results were obtained. 1. Results obtained by the conventional bacteriological method using expectorated sputum or aspirated gastric juice as the specimens. (1) The annual incidence of bacteriologically positive (smear and/or culture positive) cases constantly decreased and reached the lowest in 1981, then ceased to decline and remained at the level of 1981. (2) The annual ratio of AFB positive by smear and the ratio of smear and/or culture positive cases to the newly detected cases of pulmonary tuberculosis were constant during the entire observation period. (3) The ratio of AFB positive by smear to the newly detected cases annually increased but did not increase when the observation period was limited to within 1976 to 1991. 2. Results obtained by fiberoptic bronchoscopy in combination with conventional bacteriological methods. (1) Both the annual incidence of smear and/or culture positive cases and the ratio of these cases to the newly detected cases of pulmonary tuberculosis showed a tendency to increase in both the 80's and 90's.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[An autopsy case of acute lymphocytic leukemia associated with secondary pulmonary alveolar proteinosis and systemic aspergillosis].

A 49-year-old woman with acute lymphocytic leukemia (ALL) who had been intermittently treated with chemotherapy during a 3-year period developed cough and expectoration of increasing severity. Chest X-ray film revealed miliary shadows and bilateral hilar enlargement. Milky fluid was obtained by bronchoalveolar lavage. The intensity of these shadows showed temporary decrease, but thereafter progressively increased until the time of the patient's death. Autopsy findings were consistent with pulmonary alveolar proteinosis and systemic aspergillosis. Secondary alveolar proteinosis is rare, and in most reported cases is associated with hematological malignancy. To our knowledge, only 45 cases in which it was associated with hematological disorders have been reported. The examination of a patient with any hematological disorder, however, should include differential diagnosis of chest X-ray abnormalities to exclude secondary alveolar proteinosis, which can be lethal if left untreated.

Aspergillosis↗
PubMed1993

[Reexpansion pulmonary edema after removal of a huge localized mesothelioma].

A 70-year-old female with hypoglycemia was admitted to our hospital for progressive dyspnea. In chest X-ray film, a mass occupied two thirds of the left hemi-thorax followed by the right shift of the mediastinum. Thoracotomy revealed that a huge tumor grew from the left upper lobe and the diaphragm without invasion. The resected tumor was 2550 g in weight. Histological diagnosis was benign fibrous mesothelioma. A large amount of expectoration started soon after the resection of the tumor. Measurement of protein in tracheal fluid and serum revealed that the event resulted from the reexpansion of the left lung after the huge mass removal. The patient recovered from pulmonary edema followed by steroid administration and respiratory management. We consider that it is useful to measure the protein in tracheal fluid and serum for diagnosis of reexpansion pulmonary edema.

Aged↗