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PubMed1993

[Physico-chemical compatibility of drugs with enteral nutrition].

The physical and chemical compatibility of an enteral diet (standard Precitene) with a series of liquid preparations included in the hospital's formulary was evaluated. These preparations are included in the following groups: vitamins, antibiotics and chemotherapeutic drugs, analgesics, antiepileptic drugs, neuroleptics, bronchodilators, expectorants, antihistamines, immunosuppressors and short chain triglycerides. Phase separation, particle growth pH variation, osmolality increase and viscosity increase were studied. The results obtained indicate that the majority of the drugs studied are compatible from a physical and chemical point of view with the enteral diet used, at least during a 24 hour period, with the exception of those drugs which, because of their pH, acidify the mixture, causing problems of increased viscosity and particle growth, and of those liquid preparations of continuous oleous phase where phase separation is unavoidable. Lastly, a series of recommendations are given on cases where joint administration of drugs with enteral nutrition is suitable.

Chemical Phenomena↗
PubMed1993

[Salmonella typhimurium as the causal agent of pulmonary cavitations].

BACKGROUND: Relation between patients with immunosuppression (malignancy, renal transplant) and bacteremia by Salmonella non-typhi, specially by Salmonella typhimurium, is known. This relation has been published for patients who suffer from AIDS, and so Salmonella bacteremia could even begin the clinical disease. But even though the relation between the infection by Salmonella and AIDS is well known, and the pulmonary involvement in them has been told, this etiology as a producing agent of lung cavitation has not much documentation. METHODS: We examined three patients (two women and one man) suffering from fever of one week of duration, cough, expectoration and thoracic pain in two of them. The third patient had fever and cachexia without clinical symptoms. The man and the two women had a blood count with neutrophilia and leucocytosis in two cases and leucopenia in the other one. All of them suffered a very important depression of cell immunity (CD4 of 140, 70 and 4, respectively) and positive blood cultures for Salmonella typhimurium. RESULTS: Chest X-Ray showed, in all the cases, pulmonary cavities. CONCLUSIONS: Salmonella typhimurium must be included among the agents that can produce pulmonary cavities like Staphylococcus aureus, mycobacteria, fungus and other gram-negative bacilli.

AIDS-Related Opportunistic Infections↗
PubMed1993

Tuberculosis presenting with generalized lymphadenopathy, pulmonary infiltrates, and bone destruction in a young man.

Although tuberculosis is still relatively common in Canada, particularly among recent immigrants, one tends not to consider it very strongly in the absence of definite pulmonary symptoms and in the face of negative smears of expectorated sputum and bronchial washings. We present the case of a young immigrant from Ethiopia who presented with mild constitutional symptoms, bony tenderness of the chest wall, generalized lymphadenopathy, and rib erosions--a set of features which, in the face of smear-negative sputum and bronchial washings, raised a possibility of lymphoma. Eventually, diagnosis of tuberculous lymphadenitis and osteomyelitis was established and the patient responded well to appropriate therapy.

Adult↗
PubMed1993

Characteristics of airway responses in patients with bronchial asthma. Evaluation of asthma classification systems based on clinical symptoms and clinical findings.

Asthma was classified into three types according to clinical symptoms (clinical diagnosis, C.D.): Ia. simple bronchoconstriction type (further divided into two subtypes, type Ia-1 with 0-49 ml/day of expectoration and type 1a-2 with 50-99 ml/day); Ib. bronchoconstriction + hypersecretion type, and II. bronchiolar obstruction type. Asthma was also classified by a score related to clinical findings and examinations (score diagnosis, S.D.). The clinical features of each type of asthma according to the two classifications methods were compared. Type 1a-2 and 1b patients (C.D.) were characterized by mucus hypersecretion (more than 50 ml/day) and eosinophilia in the bronchoalveolar lavage (BAL) fluid. The characteristic findings for type II asthmatics (C.D.) were a lower %V25 value (less than 10%) and an increased proportion of neutrophils (more than 20%) in the BAL fluid. All of the patients classified as types 1a-1, Ib, and II by clinical diagnosis were evaluated as having the same types of asthma by score diagnosis. Patients with type Ia-2 evaluated by clinical diagnosis were classified as type Ib by score diagnosis, since these two types had similar pathophysiological features represented by the increased proportion of eosinophils in the BAL fluid.

Adult↗
PubMed1995

[The present situation, treatment and prognosis of drug-resistant pulmonary tuberculosis. Cooperative Study Unit of Chemotherapy of Tuberculosis of the National Sanitoria in Japan].

We studied 266 patients with drug-resistant pulmonary tuberculosis at national sanatoria in Japan. The patients included 218 men (mean age, 58 years) and 48 women (mean age, 62 years). The levels of isoniazid and rifampicin resistance were determined at 1 mcg/mL and 50 mcg/mL, respectively. The results were as follows. (1) Most patients with drug-resistant pulmonary tuberculosis were middle-aged or past middle-aged. (2) There were many cases of drug-resistant pulmonary tuberculosis in previously treated tuberculosis patients with active disease and several cases in previously untreated pulmonary tuberculosis patients. However, in some previously untreated patients active tuberculosis was convert relatively easily to inactive tuberculosis. (3) Concerning life style, bachelors who drank heavily were more likely to develop drug-resistant pulmonary tuberculosis. (4) Most cases of drug-resistant pulmonary tuberculosis had at least one cavity on chest radiographs. (5) Several patients with drug-resistant tuberculosis left the hospital against the advice of their attending doctors; therefore, it was difficult to treat their illnesses. (6) In more than half the cases in which Mycobacterium tuberculosis was resistant to isoniazid and rifampicin, tolerance to streptomycin and ethanbutol was also seen. (7) When patients with drug-resistant pulmonary tuberculosis continued to have tuberculous bacilli in their sputum after 3 months of chemotherapy, there was a tendency for them to expectorate tuberculous bacilli in their sputum. For these drug-resistant tuberculosis patients, we must pay attention not only to the medical aspects but also to the social aspects of their disease.

Adult↗
PubMed1995

[Prediction of the presence of pneumonia in adults with fever].

BACKGROUND: This study was performed to define what clinical and analytical variables were significantly associated with the presence of pneumonia in febrile patients. A predictive model which may rationalize radiologic explorations is presented. METHODS: A prospective study was carried out in two Emergency Departments in Madrid, Spain. One hundred forty-one patients presenting fever of more than 48 hours in evolution with symptomatology of the lower airway or without focal data were included. Following anamnesis, physical exploration and elemental hemogram the physician established a tentative diagnosis. Subsequently, on observation of thorax X-ray definitive diagnosis was made. RESULTS: Thirty-eight percent of the patients had pneumonia. The variables which were significantly associated with the presence of pneumonia were: history of smoking (odds ratio [OR] 2.06), alcohol abuse (OR 3.18), chronic obstructive bronchopneumopathy (OR 4.35), respiratory symptoms (OR 5.73), cough (OR 5.37), expectoration (OR 2.08), dyspnea (OR 7.03), pleural pain (OR 13.38), pathologic auscultation (OR 7.46), leukocytes (OR 6.34) and neutrophilia (OR 8.10). Clinical prior to radiologic diagnosis showed a sensitivity of 45.3% and specificity of 93.2%. Pneumonia was demonstrated in 10% of the cases with respiratory symptomatology with normal auscultation and without neutrophilia. A logistic regression model is proposed for the diagnosis of pneumonia. CONCLUSIONS: Clinical judgment prior to observation of radiography has a low sensitivity in the improvement in clinical judgment.

Adult↗
PubMedDate not supplied

[Comparative study] of beclomethasone and budesonide, with same posology (400 micrograms every 12 hours), in the control of cortico-dependent intrinsic asthma].

Inhaled steroids have rendered an undoubtful benefit in the control of airway inflammation of the asthmatic patients. Our objective was to compare clinical efficacy between budesonide (BUD) and beclomethasona depropionate (BDP), when administered at equal doses (800 micrograms/24 hours). A two ways crossed open clinical trial was designed. Thirty-three steroid dependent chronic asthmatic patients (18 females, 15 males) were included. Ages ranged from 29 to 73 years (mean = 52.5 +/- 11.7). All subjects suffered a severe asthma, with several years of activity (mean = 11.7 +/- 7.8), insufficiently controlled by inhaled steroids and bronchodilators, who required regular systemic steroids supply. The parameters compared were: the patients subjective symptoms punctuation (cough, expectoration, thoracic noises, exercise induce dyspnea and dyspnea at rest), salbutamol needs (number of inhalations/day), additional prednisone needs, sputum eosinophil counts, FEV1 measurement and inespecific bronchial reactivity control (PD20 methacoline). After a baseline week patients received one of the drugs for 6 weeks and, after a lavage week, the other drug was administered for another 6 weeks. All patients improved with both therapies. We got the following conclusions: 1) a significative decrease in salbutamol (p < 0.05-0.001) and prednisone needs (p < 0.05-0.001); 2) this decrease has been more important during BUD therapy, although without significative differences; 3) no significant variations in sputum eosinophils, FEV1 or bronchial reactivity were observed; 4) both drugs, when administered at equal doses, have probed to be equally effective in severe steroid dependent asthma control.

Adult↗
PubMed1995

Acute bronchial infection in chronic obstructive pulmonary disease.

Bacterial bronchial infection is a frequent cause of COPD exacerbation but not its only aetiology. Increased purulent expectorant appears to be its best indicator rather than fever, non-productive cough or dyspnoea. The clinician must try to recognize this condition rather than systematically prescribe empirical antibiotics. Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis are the major pathogens. Although atypical bacteria are not frequent, Chlamydia pneumoniae could play significant role. During the last years, new antibiotics, much more expensive than other regimens, are widely prescribed, often without a rational approach. In patients not already on antibiotics, sputum Gram stain is useful for deciding which patient should be treated and what would be the best anti-biotic. When it is not available, the chosen antibiotic must be at least active against three major pathogens according to the local susceptibility patterns. In patients not responding to the initial treatment, the consideration of its potential spectrum holes is then more useful than sputum examination.

Acute Disease↗
PubMed1995

Vancomycin for controlling contamination of selective Kirchner's liquid medium in the culture of gastric lavage for tubercle bacilli.

Gastric lavage (GL) was collected for culture of tubercle bacilli from children too young to expectorate sputum. The selective Kirchner's liquid medium (SKLM), routinely used as one of the media for culture of all extrapulmonary specimens, was found to often get contaminated when cultured with GL. We have shown that vancomycin at a concentration of 10 mg/l successfully reduced the contamination from about 60 to 20 per cent, and enhanced the isolation rate of tubercle bacilli from 3 to 6 per cent. Decontamination of the liquid culture before subculture on solid medium also helped to reduce the contamination rate. Vancomycin was found to be an effective selective drug for use in the Kirchner's liquid medium for culture of tubercle bacilli.

Bacteriological Techniques↗
PubMed1996

A liver-lung connection.

A 35-year-old man presented with cough, expectoration of green sputum, and right-sided pleuritic chest pain. Symptoms had begun the previous day and he had vomited the night before. The patient also complained of chronic fatigue, a 12-lb. weight loss, insomnia, right-sided back pain, and lower extremity myalgias. He denied having had fever, chills, diaphoresis, dyspnea, diarrhea, dysuria, abdominal pain, skin lesions, or jaundice.

Adult↗
PubMed1996

[Study of a disease outbreak in a home for the aged].

OBJECTIVE: To describe an epidemic outbreak in an elderly persons' home. DESIGN: A descriptive, longitudinal study. SETTING: Elderly persons' home in the Riaza Health District, Segovia. PATIENTS AND PARTICIPANTS: 90 elderly people resident at this geriatric centre. MEASUREMENTS AND MAIN RESULTS: Between January 18 and 25, 1995, there was an epidemic outbreak. Some cases had digestive symptoms: diarrhoea and vomiting, but without a temperature. Other cases had respiratory symptoms with temperature, cough, expectoration, breathing difficulty and myalgia. 25 elderly people were affected: 68% suffering the respiratory symptoms; and 32%, the digestive ones. Three people were admitted to hospital and one died. The presence of Rotavirus was found in the faeces of patients with digestive symptoms. The study-period had the highest incidence of flu in this Health District. 20% of the elderly people were not vaccinated for flu. CONCLUSIONS: Elderly persons' homes are an environment which favours the spread of germs which can cause epidemic situations.

Aged↗
PubMed1996

[Sleeve pulmonary arterial resection for bronchogenic carcinoma].

Two cases of bronchogenic carcinoma undergone left upper lobectomy (R 3) with bronchoplasty and sleeve pulmonary arterial resection via mid-sternotomy were reported. Both cases were squamous cell carcinoma originated in the orifice of the left upper lobe. Case 1 was stage IIIB (T2N3M0) bronchogenic carcinoma, its postoperative course was uneventful and died of distant lymphatic metastasis thirty-three months after operation. Case 2 was stage II (T2N1M0) bronchogenic carcinoma and its postoperative management was laborious because of hard expectoration of the sputum but is doing well fifteen months after operation. In order to preserve adequate pulmonary function and to maintain reasonable quality of life (QOL) for the patients with impaired pulmonary function, this angioplastic procedure seems to be acceptable. It is still under discussion to perform this procedure for the patients who would be able to withstand undergoing pneumonectomy, therefore we adopt this method only for every patient for whom it is difficult to maintain desirable QOL after pneumonectomy. Namely, for the patient whose predicted one second forced expiratory volume (FEV1.0) after pneumonectomy is less than 900 ml/m2, we'll be likely to try this angioplastic procedure at first.

Aged↗
PubMed1996

[Ambulatory oxygen therapy via a transtracheal catheter].

Oxygen therapy by transtracheal catheter (TTC), as described by Heimlich in 1982, was originally conceived to conserve oxygen but later proved to be truly useful as a treatment for chronic respiratory insufficiency, although the technique is little used in Spain. We conducted a one-year long prospective study of 10 patients with chronic respiratory insufficiency in whom a TTC was placed for ambulatory oxygen therapy. Complications appearing were bloody expectoration (100%), granulomas at the site of incision (20%) and accidental extubation (10%). The index of acceptance among our patients was 9%. The oxygen savings achieved amounted to 46%. The number of hospitalized days before and after insertion of the catheter amounted to 28 and 3, respectively (p < 0.001). PCO2 levels were 62 +/- 14 at baseline, 51.9 +/- 8.8 (p < 0.1) after one week, and 52.9 +/- 10 (NS) after one year. The hematocrit was 45.6 +/- 10.22 before TTC placement and 43.4 +/- 3.02 (NS) after one year. Changes in PO2, FVC and FEV1 were not statistically significant. No problems derived from TTC or liquid oxygen management.

Aged↗
PubMed1995

[Logopedic rehabilitation of laryngeal granulomas].

Posterior laryngeal granuloma is an infrequent pathology of multidisciplinary interest. Actually, its real prevalence is difficult to quantify because in some cases it is asymptomatic and in other instances it may either be reabsorbed or eliminated spontaneously. It is located at the vocal apophysis of the arytenoid or, less frequently, above it or on the laryngeal side of the arytenoid. The many etiologic factors (laryngeal intubation, gastro-esophageal refluxes, blunt trauma of the larynx, vocal dysfunction), sometimes concomitant and with the possible addition of enhancing circumstances (upper aerodigestive tract inflammation, naso-gastric tube, smoking and alcohol abuse), converge to a single pathogenetic mechanism: an ulceration of the mucosa and the pericondrium, sometimes complicated by an infection, which does not heal but instead produces a typical granulation tissue with capillaries oriented radially from the center of the lesion. Post intubation granulomas, extremely rare in children, are more frequent in females. It appears that there is no correlation with duration of intubation in that granulomas, can also occur after short general anesthesia. Idiopathic or contact granulomas are more frequent in the males. They are the result of vocal laryngeal hyperfunction, habitual throat clearing or cough-like throat clearing. Gastro-esophageal reflux of gastric juice, coughing or throat clearing may injure the mucosa. A blunt trauma of the larynx may cause a granuloma if the cartilage of the vocal process is exposed. Symptoms, when present, are dysphonia, tiredness during or after voicing, bolus, laryngeal unilateral pain, sensation of something in the throat which is mobile during breathing and swallowing, traces of blood in the expectoration. Therapeutic options are surgical, medical or logopedic. Surgery, although followed by frequent recurrences, is mandatory when the granuloma causes dispnea or if a pathologic essay is needed. Medical treatment aims at solving gastroesophageal reflux and/or inflammations of the district. Logopedic rehabilitation is the most successful therapy. Since January 1992 the Authors have been adopting the rehabilitation protocol planned by the French phoniatrician Brigitte Arnoux-Sindt for post-intubation granulomas, which, moreover, is utilyzed for all type of granulomas, including those arising during the early postoperative period after cordectomy. This protocol is analytically presented and discussed. In the cases of contact granulomas, and when there is concomitant vocal dysfunction, logopedic treatment is prolonged after granuloma dissapearance with some sessions aiming at restoring correct vocal behaviour. In all the ten patients rehabilitated up to now, granulomas disappeared after a mean of 16.3 sessions held twice a week. After several months of follow-up we had no recurrences. This clinical experience, while limited in number, seems to confirm the good results already reported in French Literature.

Adolescent↗
PubMed1996

[Respiratory organ pathology in the participants in the cleanup of the accident at the Chernobyl Atomic Electric Power Station].

The authors performed this investigation to ascertain the role of radioactive dust inhalation in the onset of respiratory diseases and determination of clinicomorphological features of such pathology. The authors have found that work in conditions of massive dust exposure, stay in the dust zone for a month and longer in 1986-1987 were the decisive risk factors of respiratory impairment. The examination covered 28 patients who had acute symptoms of inhalation damage to respiratory system when performing their job in the contaminated zone. Later on they developed chronic progressive respiratory affection having the following clinicomorphological characteristics: 1) persistent cough with hard to expectorate sputum, addition of respiratory insufficiency, sluggish recurrent infection and inflammation, deterioration of working capacity and quality of life, 2) isolated decline of specific diffuse capacity of the lungs in combination with obstructive ventilation, 3) marked disturbances of cellular immunity (reduced fraction of T-helpers and increased fraction of T-suppressors), 4) x-ray picture of diffuse pneumosclerosis and hyperairiness of the lung tissue, 5) endoscopic evidence of inflammation and atrophy of the bronchial tree mucosa, 6) numerous alveolar macrophages with foreign inclusions in the lavage fluid, such markers of Chernobyl dust inhalation as Sr, Zr, I, Cs, Ce, Np, Pu, Am, Cm registered in alveolar macrophages at roentgenospectral and roentgenofluorescent microtests, 7) defective functional activity of alveolar macrophages (free radical activation). Long-term persistence of the Chernobyl dust in the lung tissue results in essential functional and morphological changes in cell composition of the alveolar area, lung tissue undergoes structural alterations contributing to specific respiratory diseases with typical clinicomorphological characteristics.

Adult↗
PubMed1995

[Bronchiectasis in hemorrhagic rectocolitis. Apropos of a case].

Bronchectasis is a rare complication of haemorrhagic rectocolitis, 28 case have been reported in the literature. We report a case in a 40-year-old patient who presented respiratory signs 13 years after the onset of haemorrhagic rectocolitis. The diagnosis was confirmed on the bronchogram showing involvement of the lower lobes on the right and the left. Local corticosteroids given by inhalation decreased the volume of the expectorations and improved bronchial obstruction. Abundant bronchorrhoea is characteristic of bronchectasia in haemorrhagic rectocolitis as in primary bronchectasia. Response to inhaled or systemic corticosteroids is good.

Adrenal Cortex Hormones↗
PubMed1996

Pseudomonas (Burkholderia) cepacia in children with cystic fibrosis: epidemiological investigation by analysis or restriction fragment length polymorphism.

Since 1987, Pseudomonas cepacia has been isolated with an increasing frequency in the expectorants of children with cystic fibrosis followed at the Hôpital d'enfants Armand Trousseau (Paris, France). Colonization by P. cepacia may be responsible for serious secondary infections and rapid deterioration in respiratory function in these patients. Among the 130 children attending our centre, 14 (8 girls and 6 boys) aged 3 to 18, exhibited chronic colonization. 132 isolates, originating from sputum obtained between 1992 and 1994 were studied. Nine biochemical patterns and 6 antibiotic susceptibility patterns at least were defined, therefore exhibiting great polymorphism. Chromosome restriction patterns with Xba I after pulsed field gel electrophoresis enabled 4 pulsotypes to be identified: A, B, C and D. Thirteen patients harboured pulsotypes A, C and D, and 1 patient pulsotype B, the last being quite distinct from the first three. Pulsotypes A, C and D were almost similar, suggesting that closely related strains, probably the same strain, was harboured by 13 of the 14 patients. The origin could be contamination from a single source, or stem from patient-to-patient crossed transmission.

Adolescent↗
PubMed1995

[Kidney involvement in trophoblastic disease (chorionepithelioma)].

Renal involvement in chorionepithelioma is attributed to tumor destruction and metastases to the kidneys. A rare case of secondary paraneoplastic nephropathy manifesting as nephrotic syndrome in the presence of renal metastases is described. Metastatic lesion of the lungs provoked spontaneous pneumothorax. It is not easy to detect chorionepithelioma and related paraneoplastic nephropathy. Therefore, special attention should be given to puerperants with unusual clinical presentation of nephrotic syndrome, with bloody expectorations. In the above cases chorionepithelioma must not be excluded.

Adult↗