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PubMed1997

[Bacterial infectious agents implicated in lower respiratory tract infections in general practice].

The consensus of the French Society of Infectious Diseases established in 1991 states that Streptococcus pneumoniae and Haemophilus influenzae are the main causal agents of community-acquired lower airway infections and that antibiotics constitute the "prudent" solution in case of acute bronchitis which persists more than one week or in case of pneumonia in "fragile" at-risk adults. The efficacy of these "probabilistic" recommendations depends on the epidemiology of the infectious agents. The objective of this study was to identify the causal germs in lower airway infections and determine their sensitivity to the antibiotics recommended in the consensus statement. The study was conducted from December to March, in 1992 and 1993. Expectoration samples were obtained from 111 cases including 29 patients with chronic bronchitis. Seventy different strains were isolated including 24 strains of H. influenzae (3 betalactamase producers), 15 strains of S. pneumoniae (1 with reduced sensitivity to peni G: MIC = 1 mu/ml), 9 strains of S. aureus (2 methicillin resistant), and 8 strains of Branhamella catarrhalis (6 betalactamase producers). The number of positive serologies was very low: 5 Chlamydiae pneumoniae, 2 Chlamydiae trachomatis and 1 Mycoplasma pneumoniae. In conclusion H. influenzae is the most frequent germ; S. pneumoniae infections with reduced peni-G sensitivity and atypical germs are uncommon. The consensus recommendations appear to be adapted to the bacterial flore causing community-acquired lower airway infection in healthy and at-risk subjects.

Adult↗
PubMed1997

Blastomycosis in children.

Children acquire blastomycosis, with rare exceptions, through the respiratory route. Nearly half of those who are infected may be asymptomatic. Cough is the most common symptom and is usually without sputum production, and hemoptysis is not noted. Other symptoms are chest pain (described as tightness or pain when breathing), weight loss, night sweats, and loss of appetite. The severity of illness is variable and may simulate an upper respiratory infection, bronchitis, pleuritis, or pneumonia. As in adults, an overwhelming infection may cause respiratory failure even in immunocompetent children and in immunocompromised children who live in or travel to endemic areas are susceptible to infection. Some reports based on consecutive cases note extrapulmonary dissemination commonly in children, whereas dissemination is rarely noted in outbreak cases. Chronicity of the disease favors extrapulmonary dissemination. Chest radiograph patterns are alveolar infiltrates, consolidation, and nodule(s), and these may be accompanied by cavitation. Diagnosis is suspected when the symptoms that mimic common respiratory infections persist for more than 2 weeks and by a history of residence or travel to an endemic area. Chest radiographic findings of nodule(s) or cavitation further increase the suspicion. Confirmation of diagnosis is by microscopic examination and culture of sputum. When expectorated sputum is unavailable, bronchoscopy with lavage and biopsy or percutaneous needle biopsy of lung is the appropriate next step. Disease that is progressive or severe or disseminated to other organs should be treated. Amphotericin B is effective and results in excellent cure rates. Experience using oral azoles is limited in children.

Adolescent↗
PubMed1996

[Pulmonary abscess treated with postural drainage].

Case record of patients with lung abscess treated by postural drainage is presented in this paper. In young man with multiple explosive injuries lung abscess was formed two months after injury. A postural drainage with parenteral application of antibiotics has been performed. The expectoration was painful. At the seventh day there was no temperature, ESR was described at the tenth day. The general status was becoming better. At the seventeenth day patient was discharged from Hospital. Rig imaging was shown nearly completely resolution of lung abscess. Postural drainage was effective because of favorable localisation of abscess near the large bronchus and basely part of the lung.

Adult↗
PubMed1997

ATS standards for the optimal management of chronic obstructive pulmonary disease.

Tobacco smoking is the main cause of chronic obstructive pulmonary disease (COPD), and the provision of encouragement and support in smoking cessation is the best way to help patients with COPD. The three major goals of COPD management are to lessen airflow limitation, to prevent and treat secondary medical complications and to decrease respiratory symptoms and improve quality of life. Outpatient pharmacotherapy should be organized in a stepwise manner according the severity of disease, the aims being to induce bronchodilation, reduce inflammation and facilitate expectoration, although the role of anti-inflammatory and mucolytic treatment in COPD has not been clearly established. Patients who are not well controlled on optimal pharmacotherapy are candidates for enrollment in a pulmonary rehabilitation programme. Correction or prevention of hypoxaemia is a priority, and long-term oxygen therapy may prolong survival in hypoxaemic patients. With only limited data on criteria for hospital admission and the objectives of hospitalization, the published ATS standards on the management of COPD include expert consensus statements on these aspects of hospital care. Special considerations, such as surgery in the COPD patient, sleep disorders, nutrition, air travel, and ethical issues, are discussed.

Ambulatory Care↗
PubMed1997

[Clinical effect of alprazolam and trazodone on bronchial asthmatics with anxiety disorder].

Onset as well as many symptoms of asthma are said to be related to autonomic dysfunction which often appear as a result of actual daily stress of the patients. Minor tranquilizers and anti-depressants are often successful in treating such symptoms, though precise effect of these drugs on asthma is not yet available, while many still hesitate to use these drug for fear of the anticholinergic effect which may hinder the efficient expectoration of sputum which could be critical during severe asthma attacks. In this study, these drugs were evaluated by the asthma score, peak flow, acetylcholine provocation test and the suppressive effect on lymphocytes. They could be beneficial in increasing the quality of asthma therapy if employed with necessary care.

Adult↗
PubMed1997

Methods for diagnosing tuberculosis among in-patients in eastern Africa whose sputum smears are negative.

SETTING: Two University hospitals in Eastern African capital cities where large prospective studies had been carried out on hospitalized patients to determine the cause of their respiratory diseases. OBJECTIVE: To identify features that differentiated between tuberculosis (TB) and non-tuberculous respiratory disease (non-TB) in hospitalized patients from Bujumbura, Burundi (n = 111) and Dar es Salaam, Tanzania (n = 71) whose sputum smears were negative on microscopic examination for acid-fast bacilli (AFB). DESIGN: Review of clinical findings, radiologic abnormalities, and laboratory test results from 182 patients, first by univariate and then by multivariate (stepwise logistic regression) analysis to assess the contribution of each factor to the final diagnosis. RESULTS: Of the 182 patients with two or more negative AFB smears, 41 had TB and 141 had non-TB. Stepwise regression analysis revealed four easily ascertained symptoms were associated with TB: 1) cough > 21 days; 2) chest pain > 15 days; 3) absence of expectoration; and 4) absence of shortness of breath. Any two of the four diagnosed TB with 85% sensitivity and 67% specificity; any three of the four with 49% sensitivity and 86% specificity. Multivariate analysis showed that adding lymphadenopathy and hematocrit < 30% improved discrimination. CONCLUSION: This methodological approach provides a means for diagnosing TB among all AFB smear-negative hospitalized patients. In this setting, simple clinical symptoms alone are helpful. Similar studies are needed to develop a system for out-patient TB suspects.

Adolescent↗
PubMed1998

[Approach to bronchopleural fistula in patients undergoing lung cancer surgery. A prospective study].

Twenty-four cases of bronchopleural fistula were found by fiberoptic bronchoscopy performed in 526 consecutive patients undergoing surgery for diagnosis or treatment of lung cancer between February 1990 and January 1997 in Hospital General Universitario in Valencia (Spain). In 327 of the patients lung resection was performed. Clinical symptoms included fever, purulent or bloodstained expectoration, chest pain, dyspnea and general unfitness, with 83.33% of the patients having pleural empyema. Treatment was based on pleural drainage and broad-spectrum antibiotic therapy, along with planning of the appropriate surgery technique to each patient. Surgery consisted in re-thoracotomy and bronchial closure in early detection cases without evidence of infection (< 48 h); thoracostomy (Clagett) and second stage myoplasty if confirmed pleural infection; thoracoplasty in cases of incomplete fistulas that were unresolved by pleural drainage. Biological glues were delivered by fiberoptic bronchoscope in one patient. The incidence of bronchopleural fistula was studied, as were associated factors and the results obtained by various surgical techniques.

Adenocarcinoma↗
PubMedDate not supplied

Pneumocystis carinii pneumonia diagnosed by non-induced sputum stained with a direct fluorescent antibody.

Non-induced expectorated sputum (NIS) stained with tinctorial stains is not considered useful in the diagnosis of Pneumocystis carinii pneumonia (PCP). The diagnostic yield of NIS was evaluated in human immunodeficiency virus (HIV)-infected patients, when stained with a more sensitive direct fluorescent antibody for PCP-direct fluorescent antibody (PC-DFA). A retrospective analysis was carried out on fifty-five HIV-infected patients with PCP, who had NIS submitted for staining with PC-DFA. Thirty had positive NIS with PC-DFA and all had clinical courses consistent with PCP. Twenty-five had negative NIS with PC-DFA and were diagnosed as having PCP, by autopsy (n = 2), by a positive bronchoalveolar lavage (n = 10), or by having a clinical course consistent with PCP (n = 13). Thus, the sensitivity of NIS stained with PC-DFA was 55 percent (30/55). This is within the range reported in the literature for induced sputum for the diagnosis of PCP. Non-induced sputum stained with PC-DFA can be useful for the diagnosis of PCP in HIV-infected patients.

Adult↗
PubMed1997

[A case of allergic bronchopulmonary aspergillosis caused by Aspergillus terreus].

A 66-year-old woman was admitted to our hospital with a cough, wheezing, and expectoration. Chest X-ray and CT scanning revealed atelectasis and infiltration of the middle lobe, but no central bronchiectatic change. The patient had eosinophilic infiltration elevated serum IgE, RAST against Aspergillus )(A.) fumigatus, a positive immediate skin reaction, and a positive test for antibodies against A. funmigatus. Bronchoscopy demonstrated mucoid impaction that plugged the middle lobe bronchus. The mucoid plug contained A. terreus and numerous eosinophils. Because the level of the precipitating antibody for counter immunoelectrophoresis against A. terreus was higher than that at A. fumigatus, allergic bronchopulmonary aspergillus caused be A. terreus was diagnosed. Oral and inhalation therapy of corticosteroids ameliorated the symptoms and abnormal laboratory findings.

Aged↗
PubMed1996

Salivary sialic acid and cancer.

In this preliminary study the salivary sialic acid levels in 56 randomly selected cancer patients of different ages were compared with those of 70 healthy controls of similar age distribution. The cancer patients consisted of 25 women and 31 men. Twenty were suffering from lung cancer. Unstimulated whole saliva was collected by expectoration. The mean sialic acid levels were 185 +/- 22.8 mg/dl in the cancer group and 6.2 +/- 3.72 mg/dl in the controls and the difference between them was significant (p < 0.0001). The subjects were also grouped according to age and cancer type. However there were no significant differences in sialic acid levels between these.

Adolescent↗
PubMed1998

[A case of rectal cancer metastatic to the tonsil].

Metastatic tumors of the tonsils are rarer than primary tumors. Few cases of metastatic tonsillar tumor have been reported. A 51-year-old man expectorated a portion of a tumor from the left side of the pharynx after an operation for cancer metastatic to the lung. Biopsy revealed that the pharyngeal tumor was rectal cancer (adenocarcinoma) metastatic to the tonsil. To our knowledge, this is the first case of primary rectal cancer metastatic to the tonsil to be reported in Japan. The clinical features of metastatic tonsillar tumor are discussed.

Adenocarcinoma↗
PubMedDate not supplied

[White blood stains?].

Following to bullet wounds of the upper maxillary region and of the lungs great quantities of blood were expectorated by the victim soiling the clothes of the perpetrator. (These cloth consisted of a mixture of wool and synthetic fibers producing a rough surface.) The suit was washed out in cold water and dried. The only macroscopic findings were intensively stained white to grey spots missing any brown or red color portion. These were identified to consist of fibrin. Extensive examination proved the existence of blood spots of group A. Experimental stains applied to the same cloth showed identical changes after washing out.

ABO Blood-Group System↗
PubMed1998

[A case of sea water and sand aspiration during near drowning].

A 46-year-old man who had been pulled under water by a tidal wave when an earthquake occurred on July 12, 1993 was carried to our hospital the next day. He soon needed endotracheal intubation and mechanical ventilation because he expectorated sputa with sand and because arterial bloodgas analysis revealed severe hypoxemia. Chest X-ray on admission showed diffuse small nodules and areas of consolidation. Chest CT obtained on July 16 showed centrilobular small nodules bilaterally and alveolar opacities in the peribronchial region. After therapy with antibiotics and frequent bronchial lavages, sputum with sand disappeared on the 14 th hospital day and chest X-ray film and laboratory data showed marked improvement. He was discharged on October 1. A chest CT scan obtained on February 17, 1994 showed improvement of the small nodules. The areas of consolidation had also improved, but remained as linear and nodular opacities, which were considered to be organized lesions. There are few reports concerning radiographic findings particularly CT findings, after aspiration of sea water and sand during near drowning.

Anti-Bacterial Agents↗
PubMed1976

[Hygienic problems during sputum provocation by aerosol (author's transl)].

An apparatus assembly is described providing hygienic conditions to obtain sputum after aerosol inhalation. It is composed of an ultrasonic nebulizer and a half-opened exhausting hood. The patient's head is placed under the hood which inhibits the delivery of expectorated germs into the environmental space. A continuous air flow in the direction of coughing is leading the sputum particles (droplet nuclei) towards a filter system. After decontamination the air may be let off outwards or back into the room.

Aerosols↗
PubMed1998

[Multi-organ tuberculosis in a child: diagnosis and therapeutic problems].

Diagnostic and therapeutic problems in the course of tuberculosis in a 4 year old boy were described. First symptoms of disease such as specific inflammation of lymph nodes were observed in THE third month of liFe. After typical antituberculous treatment the signs of disease regressed. In consequence of the contact with an individual expeCtorating tubercle bacilli superinfection and generalization of the disease took place what led to the boy's death.

Antitubercular Agents↗
PubMed1998

[Pulmonary embolism of hydatic origin].

BACKGROUND: The right ventricle is an exceptional localization for hydatic cysts. There is a risk of hydatic embolism and chronic or acute cor pulmonale. CASE REPORT: A 63-year-old-man with an uneventful history was hospitalized for dry cough, exercise-induced dyspnea and bloody expectorations which had developed over the previous year. Multiple and bilateral opacities were visualized on the standard chest x-ray and the right border of the heart showed a bulge in the middle portion. Signs of right-sided hypertrophy were seen on the ECG. Imaging findings led to the diagnosis of multiple organ hydatiasis involving the lung, the liver the mediastinum and a ruptured hydatic cyst in the right ventricle. The cavogram revealed defect images in the superior vena cave and the pulmonary angiogram confirmed the diagnosis of hydatic embolism. Medical treatment was given but the patient died 8 months after diagnosis. DISCUSSION: Hydatic pulmonary embolism generally occurs after rupture of a hydatic cyst in the right ventricle or due to venous migration of daughter vesicles to the right heart then the pulmonary artery. Clinical manifestations are not specific although hemoptisy is the most frequent sign. Positive diagnosis, guided by echocardiographic findings, is based on the pulmonary arteriogram. Prognosis is particularly poor and depends of the patient's general status as well as the number and size of the embolized vessels. Survival rate is poor. Open heart surgery is indicated in localized forms.

Cough↗
PubMed1998

Airways microbial flora in COPD patients in stable clinical conditions and during exacerbations: a bronchoscopic investigation.

Patients affected with chronic obstructive pulmonary disease (COPD) undergo frequent exacerbations of their illness characterized by increased cough and expectoration. The precise aetiology of these episodes often remains unknown. In the absence of clinical or radiographic signs of pneumonia, bacterial or viral cultures of sputum usually provide little useful information. Thus, we performed fibreoptic bronchoscopy using a protected specimen brush (PSB) to obtain uncontaminated secretions for culture from 56 patients with COPD, 16 with stable clinical conditions and 40 affected with exacerbations of the disease. The aim of our study was to evaluate bronchial microbial flora by quantitative aerobic and anaerobic culture of each specimen. Twenty five subjects (45%), 4 (16%) in stable state and 21 (84%) with COPD exacerbations, had specimens which gave rise to significant bacterial growth (> 10(3) colony forming units.mL-1). The predominant bacteria were Streptococcus pneumoniae (in 10 cases) and alpha-haemolytic streptococci (in 6 cases); other bacteria found were coagulase-negative staphylococci and Branhamella catarralis in (2 cases each), and Proteus mirabilis, Haemophilus influenzae, Pseudomonas aeruginosa, Aerococcus viridans and Chromobacterium violaceum (each in a single case only). Although significant bacterial growth was more frequently found in patients with chronic obstructive pulmonary disease exacerbations and in those with a higher degree of bronchial inflammation, the differences between the two groups of patients were not statistically significant. Nevertheless, the results obtained in our study confirm the validity of and the need for reliable sampling methods (like the protected specimen brush) to demonstrate significant bacterial colonization of the airways in chronic obstructive pulmonary disease patients.

Aged↗
PubMed1998

Pulmonary gangrene: radiological and pathologic correlation.

Although frequently referred to as pulmonary abscess or necrotizing pneumonia, pulmonary gangrene is a distinct entity, requiring prompt medical and often surgical management. Radiographically, it begins as a lobar consolidation, usually in the upper lobes, develops lucencies, and coalesces to form a cavity. A "mass within a mass" or air crescent sign may be present. A vasculitis ensues, devitalizing parenchyma that must be drained surgically or expectorated through a patent bronchus. Serious complications of pulmonary gangrene that often lead to death are detected on computed tomography (CT) before these changes are apparent on chest radiographs. Specifically, a narrowed or obliterated bronchus impedes drainage of necrotic parenchyma and thrombosis of large vessels prevents the delivery of antimicrobial therapy. We review the literature and report this case to show the importance of CT in the early detection and management of pulmonary gangrene.

Fatal Outcome↗