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PubMed1989

Neisseria sicca pneumonia and bronchiectasis.

Neisseria sicca, although considered a harmless saprophyte, has been recognised as an etiologic agent in three cases of pneumonitis, and rare cases of endocarditis, meningitis, and osteomyelitis, particularly in immunocompromised hosts. We report the case of a 76-year-old man with a community-acquired pneumonia, in whom both sputum samples and bronchial secretions obtained with bronchoscopic protected catheter brush grew pure culture of N. sicca with abundant polymorphonuclear neutrophils. Dramatic clinical improvement only occurred after initiation of an appropriate antibiotherapy according to susceptibility spectrum of the isolated N. sicca. Bronchiectasis underlying lesions were disclosed by computed tomography. N. sicca should be added to the list of commensal organisms able to cause pulmonary infection. Moreover, the association of N. sicca and bronchiectasis has never been published.

Aged↗
PubMed1985

Effect of H1- and H2-receptor antagonists on sputum volume and lung function in patients with generalized bronchiectasis.

In a placebo-controlled trial, the effect was assessed of an histamine H1-receptor antagonist, terfenadine (60 mg twice daily) and an H2-receptor antagonist cimetidine (400 mg twice daily) on the sputum production, dyspnoea score and lung function of 12 adult patients with generalized bronchiectasis. Three of these patients had cystic fibrosis. Neither drug, whether given alone or in combination, had any demonstrable effect on any of the parameters measured. It is concluded that histamine plays no significant role in the bronchial hypersecretion occurring in bronchiectasis.

Adult↗
PubMed1988

The diagnosis of bronchiectasis.

Antibiotics and childhood immunizations have made bronchiectasis a relatively rare disease. The diagnostic imaging modality of choice is computerized tomography using 4-mm sections and 5-mm intervals. Bronchography is only indicated in cases where surgical resection is contemplated. Utilizing these imaging modalities, the pulmonary internist should have little difficulty in diagnosing bronchiectasis and initiating appropriate treatment.

Bronchiectasis↗
PubMed1988

The response of patients with purulent bronchiectasis to antibiotics for four months.

Continuous treatment with antibiotics for 16 weeks was given to 10 patients with bronchiectasis who regularly produced purulent elastase positive secretions. Macroscopic clearance of secretions (from purulent to mucoid or mucopurulent) was achieved in all patients, and this was associated with a significant reduction in the average sputum elastase content by week 16 (p less than 0.001) when elastase was only detectable in three of the patients. Lung inflammation was also reduced as reflected in the sputum to serum albumin ratios. In addition patients noted a significant improvement in well being, and breathlessness as well as in sputum colour and volume and there was a significant improvement in peak expiratory flow. After cessation of treatment the time taken for the sputum to become purulent again ranged from 15 days to 10 months (median 2.5 months), which is longer than that seen previously following short courses of antibiotic treatment. Serum levels of the acute phase protein alpha 1 antichymotrypsin fell by week 16, although this failed to reach statistical significance. However, in eight patients where data were available the levels rose significantly after treatment had finished. The concentrations were consistently higher than those seen in healthy controls, and were also elevated in less severely affected patients suggesting that bronchiectasis is always associated with some systemic effect.

Adult↗
PubMedDate not supplied

Bronchiectasis revisited.

The writer of this retrospective essay witnessed his first open chest operation during the academic year 1928-29 while an intern in general surgery at Lakeside Hospital, Cleveland, Ohio. The operative procedure was probably the first of its kind to be performed at that teaching hospital, and it involved the excision of a mediastinal tumefaction through a median sternotomy. Now, more than fifty-five years and several thousand thoracic operations later, the author recounts the evolution of pulmonary resection, particularly in relation to the therapy of bronchiectasis. The technical obstacles which delayed too long the achievement of reasonably safe and anatomically complete resections of lung are discussed, and the circuitous route trod by pioneering surgeons in their struggle toward that desired goal is described. In addition, some contributions made along the way by members of the faculty at the Yale University School of Medicine to our present knowledge of bronchiectasis--its pathologic anatomy, pathophysiology, and surgical therapy--are summarized briefly.

Anti-Bacterial Agents↗
PubMedDate not supplied

Congenital bronchiectasis due to cartilage deficiency: CT demonstration.

The CT appearance of bronchiectasis on inspiration and expiration in a patient with congenital bronchiectasis due to cartilage deficiency (Williams-Campbell syndrome) is reported. Computed tomography demonstrated characteristic findings of this syndrome, ballooning of bronchi on inspiration and collapse on expiration.

Bronchi↗
PubMed1985

Alpha-1-antitrypsin deficiency presenting as bronchiectasis.

We describe three patients with the clinical and radiographic features of progressive bronchiectasis, and without evidence of emphysema, associated with deficiency of alpha-1-antitrypsin. The association of hereditary alpha-1-antitrypsin deficiency and pulmonary emphysema is well recognized (Eriksson 1965). About half of these subjects also have chronic bronchitis as defined by persistent sputum production (Tobin et al. 1983). Bronchographically proven bronchiectasis without apparent emphysema has been reported in only one subject with alpha-1-antitrypsin deficiency (Longstretch et al. 1975).

Aged↗
PubMed1985

[Epidemiological approach to the relationship between bronchiectasis and sterility].

In recent years associations have been reported between male infertility and chronic pulmonary infections. These disorders include immotile-cilia syndrome, cystic fibrosis and Young's syndrome. For each disorder, case reports or small groups of patients have been described. However, it remains to be determined if these congenital disorders play a significant role in primary bronchiectasis (P.B). To do this, we compared the fertility rate of 35 patients (24 males, 11 females) with clinical and radiological evidence of P.B. and of 71 patients (54 males, 17 females) with secondary bronchiectasis (S.B) due to a defined chest disease (mainly tuberculosis and chronic bronchitis with emphysema). We abstracted the clinical records of this group of 106 patients, hospitalized between 1966 and 1983 for: age at the time of hospitalization, sex, diagnosis (P.B. vs. S.B.), association with sinusitis and situs inversus, socio-economic status, ethnic group, marital status and fertility (graded as 0 or 1+). The crude association between P.B. and infertility is strong (p greater than 0.10). However age may represent a confounding factor as patients with P.B. are younger (p less than 0.01) than patients with S.B., and more often single (p less than 0.01). Initially we restricted the analysis to married patients of both groups, and still got a significant association. Then we compared mean age in childless married people of both groups and observed a non-significant difference. Moreover, when we compared fertility in older patients, for example in people over 30 years old, the association still persists (p less than 0.03). In conclusion, the congenital disorders associating bronchiectasia and infertility must be looked for in the check up of P.B., all the more so as some can be cured of their infertility.

Adult↗
PubMed1979

Surgical treatment of bronchiectasis.

In recent years several reports have suggested that pulmonary resection is the treatment of choice in selected cases of primary bronchiectasis. In this study the clinical features and results of surgical treatment in 53 cases of primary bronchiectasis are described.

Adolescent↗
PubMedDate not supplied

Pulmonary function tests and airway responsiveness to methacholine in chronic bronchiectasis of the adult.

Fifty adults with chronic bronchiectasis (mean duration since diagnosis: 25 +/- 16.4 years), excluding those cases secondary to tuberculosis or hypogammaglobulinemia, were investigated by a questionnaire, a chest radiograph and lung function tests. Of these, 29 with an FEV1 greater than 1.5 1 underwent methacholine inhalation tests. Fourty-three subjects and three subjects respectively showed an obstructive or a mixed obstructive and restrictive defect, only four having normal lung function tests. Sixty-nine percent of subjects tested had a provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) less than 16 mg X ml-1. Subjects with daily sputum production had lower values of FEV1 and FEV1/forced vital capacity (FVC) compared to subjects with less than daily sputum. Subjects with clinical features of bronchial hyperexcitability had significantly lower baseline FEV1, vital capacity, and maximal mid-expiratory flow rate (FEF25-75). Subjects with lower PC20 values had significantly lower baseline FEV1, FEV1/FVC and FEF25-75. Finally, subjects with the greatest extent of radiological abnormalities had lower baseline FEV1, FEV1/FVC and diffusing capacity, and a higher residual volume. We conclude that chronic bronchiectasis is associated with significant changes in lung function tests and increased responsiveness to methacholine in the majority of affected individuals.

Adult↗
PubMed1983

[Results of the resection of basal lung segments in adult patients with bronchiectasis].

On the basis of the complex clinico-functional examination of 78 patients before and after operations for bronchiectasis the authors consider that performing preserving resections, segmentectomies in particular, still remains the main principle of the surgical treatment of adult patients with bronchiectasis. Complete clinical recovery may be achieved in half of the operated patients. A third of the patients showed an improvement in their condition.

Adult↗
PubMed1981

[Bronchiectasis in patients with situs inversus viscerum (Kartagener syndrome) (author's transl)].

The case records of 23 patients with Kartagener Syndrome in the past 10 years were reviewed. For diagnostics bronchoscopy, bilateral bronchography, lung function investigations and angiopulmonography were done. Their immunologic and genetic aspects were studied. Lung resections were performed in 17 patients, 5 of them underwent bilateral pulmonary resections. The lung specimens were investigated morphologically. As top clinico-morphologic features bronchiectasis in patients with situs inversus viscerum did not differ significantly from that without accompanying diseases. Unfavourable hereditary, dyskinesia of bronchial tree, paranasal sinus underdevelopment provoked inflammatory processes of bronchi and development of bronchiectasis.

Adolescent↗
PubMed1981

[Pulmonary blood flow in bronchiectasis patients before and after lung resection].

The analysis of data obtained in the investigation of functions of the pulmonary blood flow in 44 patients prior to and following segmentary and combined resections of the lungs fulfilled for bronchiectasis has shown that almost all the patients with bronchiectasis have the disturbed hemodynamics of the small circulation circuit. The direct relation was shown between the duration of the disease, spread of the pathological process and the degree of lung hypertension. It has been found that a resection within the limits of 6 lung segments fails to exert a negative influence on hemodynamics of the small blood circulation circuit and allows prevention of progressing pulmonary hypertension in most of the patients.

Adult↗
PubMed1980

Broncho-esophageal fistula presenting as bronchiectasis in a Nigerian child.

A case is presented of a five-year-old girl with history of intermittent episodes of cough and vomiting exacerbated by eating. A diagnosis of broncho-esophageal fistula was made on barium esophagography after she failed to improve on therapy for bronchiectasis and tuberculosis over a one-year period.The diagnostic considerations and management of broncho-esophageal fistula in the Nigerian child with bronchiectasis are described.

Bronchial Fistula↗
PubMed1980

Xenon-133 ventilation and perfusion studies in bronchiectasis.

Thirty-nine Xenon-133 ventilation and perfusion studies in 36 patients with bronchiectasis were analyzed retrospectively. These patients showed a marked reduction in ventilation with a less severe reduction in pulmonary arterial perfusion, resulting in areas of low ventilation-perfusion ratios. In those patients with bronchographic confirmation, xenon studies had greater sensitivity (0.89) than the chest radiographs (0.71). Where both the radiograph and the scan are normal, bronchiectasis is virtually excluded; therefore bronchography is not indicated.

Adolescent↗
PubMed1995

Bronchiectasis.

Bronchiectasis is a chronic suppurative respiratory disease of declining prevalence but continuing morbidity due to recurrent respiratory infections and bronchial bleeding. Literature was reviewed through a Medline search for the past 4 years. Almost all reports are retrospective case summaries. This review focuses on the clinical assessment, stressing the recognition of an impaired host and infectious contributions. High-resolution computed tomography has supplanted bronchography as a key diagnostic tool. Treatment includes prompt attention to acute bacterial infections, aerosol bronchodilators and inflammatory agents, and bronchial hygiene. The role of surgery has declined at least by the number of literature reports. Except for cures for local bronchiectasis, surgical resection is now used to palliate disease activity by removing the most affected segments and lobes.

Bronchiectasis↗
PubMed1995

Bronchiectasis. How to identify, treat, and prevent.

Bronchiectasis is not as common as it once was. In developed countries, the causes include congenital disorders, cystic fibrosis, allergic bronchopulmonary aspergillosis, and immune deficiency states. Bronchiectasis can usually be diagnosed with little difficulty by supplementing complete physical examination with chest radiography, biochemical and serologic studies, and computed tomography of the lungs. Once the diagnosis is established, therapy is aimed at eradicating the underlying disease. Surgery is indicated for local lesions and for patients with massive hemoptysis or recurrent infection that is unresponsive to medical therapy.

Bronchiectasis↗