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PubMed1993

[Bronchiectasis: indication and timing for surgery].

Despite continuous improvement in the medical treatment of bronchiectasis, a number of patients will eventually require surgery. The optimal timing of surgical resection and the efficacy of surgery need to be reassessed in this context. The records of 85 patients operated for bronchiectasis during the period 1971-1991 were reviewed. Six patients underwent repeated surgical resections. Long term results could be assessed in 73 patients (86%) by means of questionnaire or subsequent medical evaluation. Indications for surgery were: persistent symptoms under medical treatment in 43 cases (51%), local complications such as fungal superinfection or severe bleeding in 17 (20%) and 11 (13%) respectively, pulmonary mass lesions in 14 (16%). Limited resections such as segmentectomies or lobectomies were carried out in 79 cases (93%). In patients with localized disease (N = 49), surgery led to significant improvement in 91% of cases. In patients with extensive or complicated disease (N = 36), long term results of surgery were satisfactory in 62% and poor in 38%; surgery was often more aggressive in this group of patients (5 pneumonectomies), and 4 postoperative deaths occurred (in debilitated patients). Patients with localized disease and recurrent symptoms despite medical treatment should be operated before the development of complications. At this stage, surgical resection can be limited and has the potential to cure or significantly improve their condition. In contrast, patients with extensive disease are often debilitated and surgical treatment is less rewarding and sometimes poorly tolerated.

Adolescent↗
PubMed1993

Reactive mediastinal lymphadenopathy in bronchiectasis assessed by CT.

Mediastinal lymphadenopathy is commonly detected on CT. It is a non-specific finding, but because of its significance in the treatment in lung carcinoma it is important to know with which other disease states it is associated. We present a series of 42 patients in whom CT of the chest was used to confirm a clinical diagnosis of bronchiectasis. The size, number and distribution of mediastinal lymph nodes is documented. Lymph nodes were visible in 81% of patients. Nodes larger than 10 mm, the recognised maximum size for normal nodes in the U. K., were detected in 29%. In the absence of other recognised causes of lymphadenopathy in these patients, these findings confirm "reactive" mediastinal lymph node enlargement in bronchiectasis.

Adolescent↗
PubMed1993

Allergic bronchopulmonary aspergillosis in patients with and without evidence of bronchiectasis.

Allergic bronchopulmonary aspergillosis (ABPA) may complicate 1% to 2% of all cases of chronic asthma. Twenty-eight patients fulfilling the diagnostic criteria for ABPA but without evidence of proximal bronchiectasis [ABPA-S (seropositive)] were identified over a 12-year period and classified by stage. The majority of patients were in remission but all had chronic asthma. Serum anti-Aspergillus fumigatus (Af) IgG was lower in ABPA-S (n = 28) versus ABPA-CB (central bronchiectasis) (n = 58) at the time of initial presentation (IgG-Af index 3.62 versus 7.80, t = 3.46, P < or = .001). Serum IgG1-Af was significantly lower in ABPA-S as compared with ABPA-CB (t = 2.37, P = .011), as was serum IgG2-Af (t = 1.91, P = .031) and serum IgG4-Af (t = 1.78, P = .041). There were trends toward lower concentrations of total serum IgE, serum anti-Af-IgE, and anti-Af-IgA in ABPA-S. Eleven patients with ABPA-S were evaluated closely for a total of 63 patient-years and only four exacerbations with pulmonary infiltrates were identified. No patient in either group was observed to progress to end-stage or irreversible lung disease when early recognition and treatment were instituted. We conclude that ABPA-S represents the earliest stage or apparently a less aggressive form of ABPA.

Adolescent↗
PubMed1995

Bronchiectasis in children.

Bronchiectasis (BR) is a descriptive term for abnormal, irreversibly dilated, and often thick walled bronchi, usually associated with inflammation. Causes are varied but include cystic fibrosis, aspiration, post infectious airway obstruction, immune abnormalities, immotile cilia, posttransplantation states, and congenital bronchial lesions. Although BR is uncommon in children, it causes significant mortality when present. Following a period of presumed decline due to antibiotics and vaccines, BR may increase in prevalence because of AIDS, organ transplantation complications, and changing patterns of childhood immunization. As with adults, high resolution CT (HRCT) is the most useful imaging tool for diagnosis and evaluation of bronchiectasis in children.

Age Factors↗
PubMed1995

In vivo study of indomethacin in bronchiectasis: effect on neutrophil function and lung secretion.

Bronchiectasis is associated with sputum containing high levels of the proteolytic enzyme elastase, which is thought to be involved in the pathogenesis of the disease. Agents which inhibit neutrophil function and interfere with neutrophil elastase release may have a beneficial effect on the development and progression of such diseases. We have studied the effects of the nonsteroidal anti-inflammatory agent indomethacin on neutrophil function in nine patients with clinically stable bronchiectasis. All patients remained clinically stable during the study. We observed a significant reduction in peripheral neutrophil chemotaxis to 10 nmol.L-1 N-formyl-methionyl-leucyl-phenylalanine (FMLP) from a mean of 19.86 (SEM 1.35) to 8.46 (0.68) cells.field-1 after 4 weeks of therapy. There was also a significant reduction in fibronectin degradation both by resting and FMLP-stimulated neutrophils, from a mean of 1.90 (0.19) micrograms x 3 x 10(5) cells at the start of therapy to 0.87 (0.08) micrograms after 4 weeks, and from 3.17 (0.35) micrograms to 1.48 (0.05) micrograms, respectively. There was no effect on spontaneous or stimulated superoxide anion generation by neutrophils. Despite the marked changes in peripheral neutrophil function, no adverse effect was observed on viable bacterial load in the bronchial secretions. In addition, there was no difference in sputum albumin, elastase or myeloperoxidase levels, and only minor changes in the chemotactic activity of the sputum. These results suggest that nonsteroidal anti-inflammatory agents have a major effect on peripheral neutrophil function but do not appear to have an adverse effect on bacterial colonization of the airways.

Adult↗
PubMed1996

[Amyloidosis secondary to bronchiectasis].

A 77-year-old woman was hospitalized repeatly due to frequent hemoptysis and production of bloodly sputum for several years. Bronchography in 1989 revealed bronchiectasis. She had complained of abdominal pain and diarrhea since 1991, and her urine was first positive for protein in 1992. She was admitted to our hospital in October 1992 because of edema, anemia, and hypoproteinemia. Despite treatment, renal dysfunction and the gastrointestinal disorder progressed and she died in January 1993. An autopsy revealed diffuse depositions of amyloid in many organs, especially in the kidney and the gastrointestinal tract. This amyloid protein was identified as AA protein, which was suggestive of secondary amyloidosis. Bronchiectasis appears to have been the disease underlying this patient's amyloidosis.

Aged↗
PubMed1997

[Severe bronchial stenosis with upstream bronchiectasis in an arc welder: causal relation or epiphenomenon?].

This case concerns an arc welder who presented suppurative bronchiectasis and episodes of purulent left side pleurisy in relation to cystic bronchiectasis of the left lower lobe and a very severe stenosis at the origin of the main left bronchus. The medicolegal problem was to assess the causal relationship between these lesions and occupational exposure. They do not come under the heading of table 44 of the General List and we made this the aim of discretionary award in front of a regional committee of compensation for occupational disease.

Bronchial Diseases↗
PubMed1997

Pulmonary tumourlets and microcarcinoids in bronchiectasis.

A 66 year old woman underwent a left lower lobectomy for bronchiectasis. Histology revealed the presence of multiple endocrine lesions, such as neuroendocrine cell hyperplasia, tumourlets and microcarcinoids, which were widespread in bronchi, bronchioles and alveolar tissue. This case confirms the occurrence of neuroendocrine proliferations, in the setting of bronchiectasis, ranging from neuroendocrine cell hyperplasia to carcinoids, and suggests tumourlets as an appropriate model for neuroendocrine lung tumour genesis.

Aged↗
PubMed1997

[Bronchopneumonia, obstructive bronchitis and bronchiectasis in children with adenovirus infections].

During the five-year period 56 children were treated in hospital due to respiratory infections caused by adenovirus. Clinical, laboratory and radiographic signs of the illness are presented. The infections manifested as the upper respiratory tract infection in 3 patients (5.4%), obstructive bronchitis in 16 patients (28.6%), bronchopneumonia in 32 patients (57.1%) and bronchiectasis in 5 patients (8.9%). Three children were operated: bilobectomy was performed in two cases, and left-sided pulmonectomy in one case. Histologically, bronchiectasis was found in two cases and bronchiolitis obliterans in one case. In this work we tried to show the gravity, importance and consequences of the adenoviral infection of the respiratory tract in children.

Adenovirus Infections, Human↗
PubMed1998

The course of childhood bronchiectasis: a case report and considerations of hospital use.

This paper discusses the clinical history of a Finnish person from the area north of the Arctic Circle with childhood-onset bronchiectasis. It covers a period of 30 years and is aimed at analysing the significance of the disease for the use of hospital services. Childhood bronchiectasis is a rare disease nowadays and difficult to diagnose, but it still leads to serious disability in some children, requiring regular hospitalisation. The prognosis for these cases with advancing age is not known.

Adenoviridae Infections↗
PubMed2001

Cystic fibrosis and bronchiectasis: selection, timing, and outcome.

Of the nearly 30,000 Cystic Fibrosis (CF) patients alive in the United States, more than 300 die each year. Of CF deaths at least 75% are from respiratory failure due to bronchiectasis. CF patients make up about 40% of the patients undergoing bilateral transplant. Because of the shortage of donor organs relative to the demand for them, it is important to choose candidates who are in the "transplant window.'' International criteria have been developed to assist in proper selection of potential candidates, but new data suggest that some refinement of current criteria may improve this process. Appropriate prognostic models, however, are not yet completely validated. Bronchiectasis patients are usually evaluated according to the same protocols as CF patients because no large studies exist that would allow us to derive separate prognostic indicators. Outcomes for CF patients are comparable to those for other diagnoses, except in the case of living donor recipients, which are slightly lower. CF patients may face particular issues following transplant-like infections and some immunosuppression complications possibly related to their underlying disease process. In addition, CF patients seem to be at particular risk of posttransplant lymphoproliferative disorder.

Journal Article↗
PubMed1962

Post-tuberculous bronchiectasis--indications for surgical treatment.

Two hundred twelve of 308 post-tuberculous patients were found to have significant bronchiectasis; and in 105 of them, in whom certain symptoms or combinations of symptoms and conditions were observed, resectional operations were carried out. Good results were obtained in 81 per cent of the group. There were serious complications in 13 per cent. Three of the patients died, two after pneumonectomy, one after lobectomy plus segmental excision.

Adult↗
PubMed1950

Tuberculosis as a cause of upper lobe bronchiectasis.

Bronchiectasis occurs frequently in association with pulmonary tuberculosis and is caused primarily by tuberculous bronchitis. It is common in all types of tuberculosis, especially in the fibroid lesion stage. It may occur with active tuberculosis and become part of the tuberculous picture. It may also occur with inactive tuberculosis and then present a distinct symptom complex. It is easy to diagnose. It is a relatively benign disease and usually no special treatment is needed; but when it becomes severe, pulmonary resection is the procedure of choice.

Bronchiectasis↗
PubMed1980

Bronchiectasis in pediatric patients resulting from aspirated grass inflorescences.

A grass inflorescence (flowering head) aspirated by a child is difficult to diagnose, and frequently cannot be retrieved by bronchoscopy. Of four pediatric patients with aspirated grass inflorescences, two had severe hemoptysis and the other two were septic at the time of diagnosis. Their chronic debilitation and bronchiectasis necessitated an eventual pulmonary resection, with full recovery in all four patients.

Adolescent↗
PubMed2004

Bronchus-associated lymphoid tissue lymphoma arising in a patient with bronchiectasis and chronic Mycobacterium avium infection.

We describe a 67-year-old woman with bronchiectasis and Mycobacterium avium complex infection who underwent wedge resection of her pulmonary infiltrates because they were progressing despite antibiotic therapy. In addition to the expected granulomatous changes, she was found to have a B-cell lymphoma of bronchus associated lymphoid tissue (BALT). Despite normal bone marrow morphology, marrow involvement was demonstrated by flow cytometry. Her lymphoma remains suppressed with antimycobacterial therapy 6 months after resection of bulk disease.

Aged↗
PubMed2002

Clinical, physiologic, and roentgenographic changes after pneumonectomy in a boy with Macleod/Swyer-James syndrome and bronchiectasis.

Macleod/Swyer-James syndrome is an uncommon and complex disease characterized by roentgenographic hyperlucency of one lung or lobe due to loss of the pulmonary vascular structure and to alveolar overdistension. This syndrome seems to be an acquired disease that follows viral bronchiolitis and pneumonitis in childhood. It must be differentiated from many other causes of unilateral lung "transradiancy" on the chest roentgenogram, such as those related to congenital bronchial and/or vascular abnormalities. We here describe an 11-year-old patient with Macleod/Swyer-James syndrome and bronchiectasis resulting in severe recurrent bronchopulmonary infections. Despite the severe impairment of pulmonary function, the patient underwent resection of the right lung with progressive improvement of clinical and physiologic parameters.

Bronchiectasis↗
PubMed2003

Non-CF bronchiectasis: clinical and HRCT evaluation.

Childhood bronchiectasis not related to underlying disease is still common in some populations in affluent countries. The aims of the study were to: 1) describe demographics, 2) evaluate the effectiveness of routine investigations, and 3) determine the relationship between spirometry and radiology scoring systems, in children with chronic suppurative lung disease (CSLD) living in Central Australia. Data of children living in Central Australia aged </=15 years with noncystic fibrosis CSLD were identified over 2 years. Chest high-resolution computed tomography (HRCT) scans were interpreted by a pediatric radiologist and scored according to three systems. Sixty-five children were identified, resulting in a prevalence of at least 14.7/1,000 aboriginal children aged </=15 years. Comorbidities (most common: suppurative otitis media in >70%) and early hospitalisation for pneumonia were common (median age, 0.5 years). Previous admissions for pneumonia were almost universally present and significantly more common than bronchiolitis (95% CI for proportional difference, 0.4-0.51). Although the majority did not have a treatable underlying cause, investigations had significant impact on management in 12.3% of children. None of the chest HRCT scores related to any spirometry data. In conclusion, CSLD is unacceptably common in indigenous children of this region, commences early in life, and is associated with significant comorbidities. Spirometry data do not reflect the severity of lung disease in HRCT scans. While improvement in the living standards is of utmost importance, the medical management that includes thorough investigations of these children should not be neglected.

Adolescent↗