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PubMed1977

Usefulness of transtracheal puncture and aspiration in the bacteriological diagnosis of pulmonary tuberculosis.

Transtracheal puncture enables two samples of bronchial secretions to be taken-the product of transtracheal aspiration and simultaneously expectorated sputum (obtained in 71% of the cases)-for the purpose of testing for Mycobacterium tuberculosis in cases of suspected pulmonary tuberculosis. Two groups of patients were studied: Group I: 100 patients who were poor expectorators and who all underwent transtracheal puncture; Group II (Control): 100 patients who expectorated well or who had been given gastric lavages immediately on admission. Laboratroy analyses revealed M. tuberculosis in at least one of the samples obtained from each of the 200 patients. The authors compare the efficiency of the methods used within each group and between the two groups. Samples obtained by transtracheal aspiration and simultaneous expectoration (75% of positive results) more often contained M. tuberculosis than the other Group I samples (64% of total positive results; 64% of positive results for spontaneous sputa, 65% for gastric fluids), and as often as the Group II samples (76% of total positive results), particularly the expectoration samples (78% of positive results). Simultaneously expectorated sputum more frequently contained M. tuberculosis (82% of positive results) than transtracheal aspiration (69% of positive results). Transtracheal puncture and/or simultaneous expectoration were the only examinations revealing M. tuberculosis in 34 patients in Group I. Non-specific bacteriological findings are not relevant. However, the authors point out that this technique is not always innocuous (although no serious complications were observed in this series), and that transtracheal puncture must always be carried out by physicians trained in the technique.

Adult↗
PubMed1976

Pneumocystis carinii pneumonia. Diagnosis by examination of pulmonary secretions.

To determine if examination of respiratory secretions is useful in diagnosing Pneumocystis carinii pneumonia, smear preparations of expectorated sputum, tracheal aspirates, and transtracheal aspirates stained by the Gomori methenamine silver nitrate method were examined. Pneumocysts were observed more frequently in material obtained by transtracheal aspiration than in secretions obtained by the other methods. Transtracheal aspiration yielded material containing pneumocysts in 8 (13%) of 60 patients; each had pulmonary infiltrates and clinical courses consistent with P carinii pneumonia. Of 330 smear preparations examined from expectorated sputum, three patients had pneumocysts in their sputum and one had organisms in both transtracheal aspiration and expectorated sputum; all three had pneumonia. This study provides evidence that transtracheal aspiration is a useful initial step in the approach to the diagnosis of P carinii pneumonia.

Adult↗
PubMed1978

The Philadelphia Pulmonary Neoplasm Research Project. Symptoms in occult lung cancer.

In a prospective study of 6,027 older men screened every six months for ten years by means of chest photofluorograms and questionnaires regarding symptoms, 121 developed lung cancer after the first examination. Eighty-five men with lung cancer had the opportunity to be screened eight times before the tumor was detected by chest x-ray film, but only 33 actually reported that often. These 33 men were compared with matched controls for symptoms before the neoplasm was detected radiologically. The common symptoms of expectoration and chronic cough showed a significant increase in frequency over time in the cases of cancer, while only expectoration showed a slight increase in the controls. Uncommon symptoms more suggestive of lung cancer (hemoptysis and worsening cough) occurred in only four men prior to detection of cancer. Symptoms are seldom useful in the detection of occult lung cancer, but the appearance of expectoration and chronic cough in older male smokers should raise a suspicion of this disease.

Chronic Disease↗
PubMed1976

Optimal visualization of esophageal varices.

Twelve patients with known esophageal varices and willingness to cooperate were included in the study. Medications administered were placebo, 2 mg of glucagon, and 30 mg of propantheline bromide. All medications were given double-blind and crossover. On the basis of this study the authors believe that for optimal visualization of esophageal varices the following is the procedure of choice: (1) the patient should remain horizontal (this is best done in the left lateral position for comfort and ease of expectoration) for ten minutes after swallowing high density barium; (2) the patient should "clear his throat" frequently and expectorate all saliva (barium sticks to the pharynx and makes the patient want to swallow and "clearing his throat" by forced expiration helps the patient to expectorate this coating and prevents swallowing); (3) filming should be done in expiration in the supine (left posterior oblique to table top) position; and (4) in equivocal cases the examination can be repeated with an anticholinergic drug if the patient has no contraindications to its use. The patient should empty his bladder just before administration of the drug. The intelligent use of these factors should result in a saving of both fluoroscopic time and film, and give the radiologist a safe optimal diagnostic yield.

Adult↗
PubMed1979

Iodine-induced hypothyroidism and its effect on the severity of asthma.

Among 1107 patients with asthma or chronic asthmatic bronchitis and 96 with hypothyroidism we found 12 patients with both diseases. Seven of these patients had hypothyroidism induced by iodine-containing expectorants. Five of 209 patients with hyperthyroidism had coexistent asthmatic lung disease, but none of these five had been taking iodine. The severity of asthma is considered in relation to changes in thyroid function following withdrawal of iodine. Three patients had an exacerbation of their asthma, while another three had no change in their asthma when the iodine treatment was discontinued and the euthyroid state subsequently restored. All six patients had a marked improvement of their general wellbeing when the euthyroid state was re-established. It is concluded that treatment with iodine-containing expectorants causing hypothyroidism is unwise and should be withdrawn even when the patients praise the beneficial effect of iodine on the asthma per se.

Aged↗
PubMed1978

Effect of the mucoregulator S-carboxy-methyl-cysteine in patients with chronic bronchitis.

Twenty patients with stable chronic bronchitis entered a double-blind study in which changes in clinical and respiratory function and biochemical and rheological variations were examined after treatment with the mucoregulator S-carboxy-methyl-cysteine (S.C.M.C.). After one week of single-blind placebo, a two week double-blind study was initiated with placebo or oral S.C.M.C. 3 g/24h. After two weeks, a significant clinical improvement was observed in patients treated with S.C.M.C. During treatment, there was no change in respiratory function, although a drop in FEV1/VC was noted in the placebo group. A significant increase in the viscosity of the expectorations was observed after treatment with S.C.M.C. for two weeks. The levels of secretory IgA and of serum albumin in the expectorations remained stable, whereas in the placebo group, there was a slight but significant increase in serum albumin. In this group of non-infected chronic bronchitic patients, S.C.M.C. appeared to normalize the secretory function of the bronchial mucosa by preventing inflammation and enhancing the viscoelastic properties of bronchial secretions.

Aged↗
PubMed1979

Physiologic effects of chest percussion and postural drainage in patients with stable chronic bronchitis.

The effects of a 30-minute period of chest percussion and postural drainage were compared to a sham treatment (infrared lamp) in 35 patients with stable chronic bronchitis and to a period of directed coughing in 11 of these same patients. There were no differences in subjective responses or arterial blood gas levels following therapy. Spirometric studies showed small improvements over baseline values following either treatment but no difference between active and sham treatments. The volume of sputum expectorated during percussion and drainage was significantly greater than during the infrared warming (5.5 vs 1.4 ml) or during the directed coughing (9.0 vs 3.5 ml). Although chest percussion and postural drainage are effective in augmenting the volume of expectorated sputum, no significant alternations in air flow or gas exchange after two hours were demonstrated.

Adult↗
PubMed1977

Bacterial sputum cultures. A clinician's viewpoint.

The expectorated sputum and transtracheal aspiration bacterial culture data presented by Murray and Washington were reanalyzed after removing several species unlikely to cause pneumonia in adults. After these exclusions, mean numbers of species isolated per specimen were not excessive. Those specimens with more than 25 leukocytes per field (groups 3, 4, and 5) has similar numbers of isolates per specimen (1.04, 1.05, and 1.05) compared with those with fewer than 25 leukocytes per field (groups 1, 0.57, and 2, 0.59). For this reason and others, it is recommended that expectorated sputum samples be accepted for bacterial culture if they contain more than 25 leukocytes per field.

Bacteria↗
PubMed1979

Elimination of test particles from the human tracheobronchial tract by voluntary coughing.

The effect of coughing on the elimination of inhaled 6 micrometer radioactively tagged teflon particles in humans was studied by external measurements of the radioactivity retained in the lungs before and after 1--2 min of voluntary coughing. In six healthy subjects coughing produced no substantial elimination of the particles. Six out of eight patients with lung disease produced expectorate and also eliminated particles from the lungs by coughing. The other two patients had no phlegm, did not produce any expectorate and did not eliminate particles by coughing. An increased amount of tracheobronchial secretion thus seems to be necessary for coughing to be effective. In the patients, the elimination of particles by coughing was fairly reproducible, suggesting that the test model may be useful for investigation of the influence of physiological and pharmacological factors on the elimination process.

Adult↗
PubMed1975

Chronic obstructive airway diseases. Current concepts in diagnosis and comprehensive care.

Physicians and paramedical personnel often find the early diagnosis and differentiation of obstructive airway diseases to be a challenging problem. The history and physical examination are often not enough to allow the physician to detect either the presence of, or determine the type of, disease present. Patterns of pulmonary function abnormality to determine the presence of obstructive or restrictive defects are discussed. Guidelines useful in the differentiation of obstructive airway diseases are presented. Once a patient with COAD is assessed, the physician needs to outline a therapeutic program after establishing goals with the patient. These goals include (1) improved ability for the patient to achieve relief from symptoms and (2) improved capacity to carry out the activities of daily living. The therapeutic modalities available for the comprehensive care of patients with COAD are discussed. These include general factors such as patient and family education, avoidance of smoking and other inhaled irritants, avoidance of infection, a minimum stress environment, high fluid intake, and proper nutrition. The appropriate use of the medications most commonly employed in the teatment of these patients, eg, bronchodilators, expectorants, antimicrobials, corticosteroids, cromolyn, digitalis, and diuretics, are individually discussed. The use of such respiratory therapy techniques as aerosol therapy, intermittent positive pressure breathing, and oxygen therapy are considered. Application of the specialty of rehabilitation medicine to patients with obstructive airway disease is described. This includes physical therapy with breathing retraining, clapping and postural drainage, and exercise reconditioning, occupational therapy with attention to energy conservation in activities of daily living, psychological considerations, and vocational rehabilitation. Definite benefits that can be demonstrated if the physician employs this type of systematic respiratory care program include a decrease in the frequency and duration of hospital admissions, socioeconomic gains from reduced hospitalizations, a reduction in anxiety, depression and somatic concern, the return of patients to positions of employment and the establishment of a better quality of life. Persistence in making sure the patient continues in a systematic program, including both pharmacological and nonpharmacological modalities, may be the means of assuring maintenance or even improvement in his health. The day-to-day treatment for the majority of patients should remain in the hands of the primary physician. However, community resources must be established to allow the primary physician to provide these patients with adequate comprehensive respiratory care. Development of three levels of care (the primary physician, community respiratory rehabilitation units, and the regional respiratory center) should make superior respiratory care available to every patient with obstructive airway disease.

Adrenal Cortex Hormones↗