[Tracheobronchomegaly: a frequently ignored cause of recurrent bronchopulmonary infections].
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Biomedical subjects
Publications and source records attributed to T Prigogine.
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During an 8-year period (1970-1977), 24 strains of Salmonella spp. were isolated in 24 renal transplant recipients. In 19 cases (79%) the infection had an unusual presentation (extradigestive focus or bacteraemia), and 15 of the offending strains belonged to the serotype typhimurium. During the same period 161 strains of Salmonella spp. were isolated in 159 adult patients admitted to units other than the renal transplantation unit; 52% of the infections presented as gastroenteritis, and S. typhimurium accounted for only 25% of unusual presentations. However, the lysotypes and biotypes of S. typhimurium were as diverse in the renal transplantation unit as in other hospital units. The study failed to demonstrate interhuman transmission of Salmonella spp. within the renal transplantation unit.
The present study concerns eighteen chronic alcoholics with minimal liver damage. A significant reduction in total serum T4 with an accompanying drop in circulating TBG was observed in these otherwise euthyroid patients. During alcohol withdrawal, we observed a rapid increase in T4 and TBG into the normal range. We suggest that the fall in the level of circulating thyroxine-binding globulin is related to a defect in its synthesis or secretion by the liver due to ethanol consumption. Caution is recommended in the interpretation of thyroid function tests in chronic alcoholics.
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Ninety-one strains of coagulase-negative Staphylococci isolated from urine specimens of patients with urinary tract infection were classified by the kloos and Schleifer method. The study confirmed the pathogenic role played by S. saprophyticus--an organism characterized by its biological properties and its resistance to novobiocin--in UTI of young female out-patients. On the other hand, coagulase-negative Staphylococci sensitive to novobiocin were mostly found in the urine of elderly in-patients who had undergone instrumental procedures or who presented with urinary tract abnormalities. Precise identification of coagulase-negative Staphylococci urinary isolates is needed, since it has epidemiological, clinical and therapeutic applications.
A 71-year-old patient living in a street where major road works were taking place developed diffuse bronchopneumonia with changes in hepatic and renal biochemical tests. Since neutrophilia was moderate and all bacteriological investigations were negative, the patient was given erythromycin and was tested for antibodies directed against Legionella pneumophila. The titers of these antibodies rose from 32 to 2048 after one month. The patient was cured.
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During a hospital outbreak of Pseudomonas cepacia a traditional epidemiological investigation was proved to be misleading. Suppression of the suspected antiseptic did not stop the epidemics. A further investigation proved that it was due to the intravenous injection of contamineted anesthetic vials. Fever, chills, lack of hemodynamic disorders and of metastatic absceses characterize the clinical state of the infected patients. The removal of the catheters for perfusion was sometimes necessary to stop the bacteraemia. A lack of medical information is responsible of the outbreak.
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Twenty patients with stable COPD (mean age 67.8 yr; mean FEV1 1.08 1), all limited by ventilation at maximum exercise, were randomly allocated after a four week control period, to an eight week programme of either inspiratory resistive training (IRT), with a P Flex device, or conventional breathing retraining (BR). Exercise performance was evaluated every four weeks, using a 12-min walking test, an incremental progressive exercise on a cycle ergometer and a cycle endurance test. Inspiratory muscle endurance was measured as the highest tolerated resistance for 10 min on a P Flex device. IRT produced a significant (p less than 0.05) increase in the highest tolerated resistance, but IRT and BR failed to improve lung function or exercise performance. The present study shows that in COPD patients with ventilatory limitation on exercise an IRT programme may fail to improve exercise performance, in spite of an efficient training effect on the endurance of the inspiratory muscles.
The aim of this study was to compare induced sputum versus bronchoscopy in a non selected population. An induced sputum and a bronchoscopy with aspiration of secretions and bronchoalveolar lavage (BAL) were proposed to 30 patients with suspected lower respiratory tract infection, including 14 subjects with AIDS. Induced sputum failed in 3 patients, while endoscopy could not be performed (contra-indication, refusal or failure due to lack of cooperation) in 7 patients; a technical failure for BAL was observed in 3/23 cases. Contamination by oral germs was significantly less frequent with BAL (4/20) than with aspiration (15/23) or induced sputum (17/27). A relevant pathogen was cultured from induced sputum in 7/27 cases (3 mycobacteria, 4 usual pathogens) from aspiration in 3/23 cases (one mycobacterium, 2 usual pathogens) and from BAL in 4/20 cases (one mycobacterium, 3 usual pathogens). These results suggest that induced sputum is a promising method when difficulties in performing bronchoscopy are expected (severe respiratory insufficiency, psychiatric disease, lack of cooperation).