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At least 613 records · Page 34Linked to original sources
PubMed2001

The 24-h effect of mannitol on the clearance of mucus in patients with bronchiectasis.

STUDY OBJECTIVE: To investigate the acute effect of mannitol on the clearance of mucus, and (1) the 24-h mucus retention, and (2) the mucus clearance rate and lung function 24 h after inhalation of a single dose of mannitol. DESIGN: Clearance of mucus was measured on 3 consecutive days using (99m)Tc-sulfur colloid radioaerosol and a gamma camera. INTERVENTIONS: Mannitol, 330 +/- 68 mg (mean+/- SD), was inhaled using a dry powder inhaler only on day 2. PATIENTS: Eight patients with bronchiectasis (age range, 29 to 70 years). MEASUREMENTS AND RESULTS: On each day, lung images were collected over 2 h and at 24 h. Key findings of the study are as follows: (1) the 24-h retention of mucus was reduced the day after mannitol had been inhaled, compared to the day without mannitol (day 1) in the whole right lung (57.6 +/- 6.2% vs 68.1 +/- 5.9%), central (47.5 +/- 6.7% vs 56.9 +/- 6.5%), intermediate (61.7 +/- 5.6% vs 73.8 +/- 5.5%), and peripheral regions (70.9 +/- 4.3% vs 86.6 +/- 4.6%)(p < 0.02); and (2) mannitol helped patients clear mucus within 2 h that might otherwise take up to 24 h, from the whole right lung and defined regions. However, clearance over 60 min measured 24 h after mannitol inhalation was not significantly different to baseline clearance without mannitol (8.7 +/- 1.9% on day 1 vs 9.7 +/- 3.7% 24 h after mannitol; p > 0.8). The patients maintained the same lung function the day before and after mannitol had been inhaled: FEV(1) (percent predicted), 79 +/- 5 on day 1 vs 80 +/- 5 on day 3; and forced expiratory flow, midexpiratory phase (percent predicted), 50 +/- 6 on day 1 vs 51 +/- 6 on day 3; p > 0.6). CONCLUSIONS: Mannitol inhalation acutely increases clearance of mucus, and this effect extends beyond the acute study period, resulting in decreased mucus retention at 24 h.

Adult↗
PubMed2001

Treatment With tobramycin solution for inhalation in bronchiectasis patients with Pseudomonas aeruginosa.

A randomized, placebo-controlled, multicenter trial evaluated the safety and efficacy of 300 mg aerosolized tobramycin solution for inhalation (TSI) administered twice daily for 4 weeks in 74 bronchiectasis patients colonized with Pseudomonas aeruginosa (PA). Patients were evenly divided between TSI therapy and placebo. After 2 weeks of treatment, patients treated with TSI had a mean reduction in sputum PA density of 4.8 log(10.) This reduction was maintained for the duration of treatment. The placebo group showed no change in PA density during the study. Two weeks after the end of therapy, PA had been eradicated in 13 TSI-treated patients. PA was not eradicated in any placebo patients. Among those colonized with Staphylococcus aureus at baseline, 6 of 9 patients in the TSI group and 2 of 9 patients in the placebo group were culture negative for this organism 2 weeks posttreatment. Sixty-two percent of TSI-treated patients were judged by a physician as having an improved general health status, compared with 38% of placebo-treated patients. Dyspnea, wheezing, and chest tightness were reported more frequently in the TSI-treated patient group than in the placebo-treated patient group.

Adult↗
PubMed1989

Bronchiectasis and progressive respiratory failure following smoke inhalation.

A 49-year-old man who sustained inhalational injury in a fire 23 years ago developed bronchiectasis 12 years later and hypercapnic respiratory failure with cor pulmonale 20 years following the injury. Delayed onset of chronic respiratory failure should be considered among the long-term complications of inhalational injury.

Bronchiectasis↗
PubMed1991

Crackles in patients with fibrosing alveolitis, bronchiectasis, COPD, and heart failure.

We have studied the crackling lung sounds of ten patients with cryptogenic fibrosing alveolitis, ten with bronchiectasis, ten with chronic obstructive pulmonary disease, and ten with heart failure by analyzing frequency, waveform, and timing of crackles. The upper frequency limit of inspiratory sounds was higher in CFA than in COPD or in HF. The period of crackling was shorter in COPD than in CFA or BE. Inspiratory crackling terminated significantly earlier in COPD than in CFA, BE, or HF. The initial deflection width and the two-cycle duration of the expanded waveforms of crackles were smaller in CFA than in BE, COPD, or HF. The largest deflection width was smaller in CFA than in BE, HF, or COPD and smaller in BE than in HF. The results indicate that crackling lung sounds in different diseases have distinctive features and that their analysis can be of diagnostic value.

Bronchiectasis↗
PubMed2004

Treatment of paediatric non-cystic fibrosis bronchiectasis.

Non-cystic fibrosis (CF) bronchiectasis, the abnormal dilatation of bronchial airways, is a heterogeneous condition caused by a variety of lung insults and results in significant morbidity and mortality. Although frequently reported as being an uncommon respiratory disease in the developed world, its impact on the respiratory health of specific populations has recently received increased attention. There are limited data on which to base management strategies. This article reviews the evidence for current treatment practices, provides an opinion on best practice, and discusses likely new therapies. Consideration is also given to the pharmacoeconomic hurdles that face the populations most affected.

Bronchiectasis↗
PubMed1996

Two cases of severe bronchiectasis successfully treated with a prolonged course of trimethoprim/sulfamethoxazole.

Two patients with severe bronchiectasis, one patient without other disease and the other with hyper IgE syndrome, were successfully treated with long-term therapy with low doses of trimethoprim and sulfamethoxazole (TMP-SMZ). Recurrent respiratory infections with productive cough and high fever were resistant to various antibiotics and often disturbed the patients' activities in daily life. However, they showed marked improvement following TMP-SMZ therapy, which was started for methicillin-resistant Staphylococcus aureus (MRSA) infection. MRSA disappeared some months later, but Pseudomonas aeruginosa appeared again in the sputum. Both patients, however, have remained free from symptoms for over one year.

Adult↗
PubMed2000

Mucoid impaction caused by monokaryotic mycelium of Schizophyllum commune in association with bronchiectasis.

A 51-year-old female was admitted to our hospital because of fever, cough, and hemoptysis. A chest radiograph showed a partial collapse of the left upper division and infected bullae in the left upper lobe. Bronchoscopic examination showed thick mucous plugs in the left upper bronchus. The isolates of the plugs proved to be Schizophyllum commune. Neither accumulation of eosinophils nor Charcot-Leyden crystals were present in the plugs. Mild ectatic changes of the left upper bronchus had been observed 17 years previously. We describe the first case of mucoid impaction, which was independent of the immunological reactions, caused by S. commune in association with bronchiectasis.

Antibodies, Fungal↗
PubMed1983

Reiter's syndrome in a 73-year-old man with bronchiectasis.

We report the case of what we believe to be the oldest person to develop Reiter's Syndrome. There was no evidence of preceding gastro-intestinal or genito-urinary infection but the patient had post-tuberculous bronchiectasis and the role that this might have played is examined.

Age Factors↗
PubMed1998

Mast cells in bronchiectasis.

Bronchiectasis (BE) is a chronic severe inflammatory lung disease characterized by frequent bacterial infections and polymorphonuclear neutrophil-dominated inflammatory reaction. We have attempted to elucidate the role of mast cells (MCs) in BE lung inflammation by measuring in the bronchoalveolar lavage fluid (BALF) the MC-derived tryptase levels by radioimmunoassay and immunoblotting and also by measuring the tryptase-like activities in 36 BE patients and in 14 healthy controls. The amount of MC in the lung tissue was assessed by immunohistochemical staining of resected lung tissue samples. Based on the clinical and radiological parameters the patients were divided into subgroups according to the severity of the disease. The MC tryptase concentrations (microg/L; median (range)) in BALF of BE patients were higher compared to healthy controls (4.7(1.4-20.1) and 2.0 (0.1-3.5), respectively, P < 0.01). Tryptase concentrations in the groups of mild, moderate and severe BE were 3.8 (0.9-10.8), 4.3 (3.0-12.6) and 9.6 (1.2-20.1), respectively. All the values differed significantly from those observed in the healthy controls. The tryptase-like activities (nmol/sec/L) in BE patients were also markedly increased (174 (31-2874)) compared to healthy controls (28 (9-45) P < 0.0001). The tryptase-like activities in the patient subgroups were 45 (36-598) in mild, 91 (31-1437) in moderate and 1336 (37-2874) in severe BE. Again, all values differed significantly from those observed in the healthy controls. Moreover, immunoblot experiments disclosed the most intensive immunoreactivity of the 27.5 kD tryptase monomer in BALF of patients with severe BE followed by weaker immunoreactivity in groups of moderate and mild BE and in healthy controls. No significant difference could be observed in the amount of tryptase-positive cells between BE patients and controls. However, the presence of degranulated MCs was more evident in BE lung tissue. Significant correlation could also be observed between the degree of activation of latent procollagenase and tryptase concentration (r = 0.8, P = 0.0004) in BALF of individual BE patients. The observed strong correlation between tryptase levels and disease severity suggests that MCs may be involved in the inflammatory reaction in the BE lung. Importantly, the high levels of tryptase, observed also in patients with mild BE, suggests that activation of and proteinase release from MCs may be one of the reasons for the perpetuation of tissue injury even during the clinically quiescent periods in BE.

Adult↗
PubMed1997

Bronchiectasis resulting from aspirated grass inflorescences.

Bronchiectasis due to aspiration of grass inflorescences is described in three children. One patient spontaneously expelled a grass head by coughing and was not operated on. The grass inflorescence was found in the right lobe's medial segment bronchi in the second case and in the pleural cavity of the third. Pulmonary resection was performed in both cases. The clinical manifestations were of both "lodging" and "extrusive" types of aspirated grass inflorescence. This possibility must be considered in the differential diagnosis of chronic pulmonary infections in children.

Bronchi↗
PubMed1999

Rapid mycobacterial tuberculosis detection in bronchoalveolar lavage samples by polymerase chain reaction in patients with upper lobe infiltrates and bronchiectasis.

In areas where tuberculosis is endemic, a positive sputum acid-fast bacilli (AFB) smear is frequently regarded as almost diagnostic of pulmonary tuberculosis (PTB). The main problem arises when the AFB smear is negative. The main aim of this study was to determine the clinical utility of rapid mycobacterial tuberculosis (MTB) detection in bronchoalveolar lavage (BAL) samples by polymerase chain reaction (PCR) in 52 patients who underwent diagnostic bronchoscopy for suspected PTB. These patients had either upper lobe infiltrates (n = 31) or bronchiectasis (n = 21). Mycobacterial culture is usually used as the gold standard of diagnosis. We chose to define active PTB based on positive mycobacterial cultures and/or histological evidence of caseous necrosis and AFB, and/or when there was clinical plus radiological improvement following therapy. We compared AFB smear, respiratory mycobacterial culture, BAL PCR for MTB and clinical active PTB. Four patients who were smear and culture negative had clinical and radiological clearance following anti-tuberculous therapy showing that using mycobacterial culture as a gold standard may have its limitations. When Kappa (a chance-corrected measure of agreement) was calculated for acid-fast bacilli smear and BAL PCR against our definition of active PTB, it was 0.28 (fair agreement) and 0.73 (substantial agreement), respectively. BAL PCR gave a sensitivity, specificity, positive and negative predictive values of 66.7%, 100%, 100% and 88%, respectively, for the group with upper lobe infiltrates. We also demonstrated that BAL for PCR has a good concordance with the final diagnosis of active tuberculosis.

Adult↗
PubMed1999

Left middle lobe resection for bronchiectasis in Kartagener's syndrome.

We report the case of a young girl with Kartagener's syndrome who suffered from severe bronchiectasis confined to the left middle lobe. Due to chronic abscedation which failed to respond to medical therapy, resection of the left middle lobe was performed. Although there was an initial clinical benefit, afterwards she had to be treated again for recurrent infectious exacerbations.

Adolescent↗
PubMedDate not supplied

Bronchiectasis due to ciliary aplasia in Turner's syndrome.

A seven-year-old girl with Turner's syndrome, who suffered from recurrent respiratory system infections since birth, was investigated to determine the etiology of bronchiectasis. Electron microscopy of recurrent nasal biopsy specimens revealed ciliary aplasia. Ciliary aplasia in Turner's syndrome, has not previously been reported.

Bronchiectasis↗
PubMed2003

Localized bronchiectasis is a definite association of coronaro-bronchial artery fistula.

An 81-year-old smoker presented with acute coronary syndrome. Coronary angiography revealed severe double-vessel disease, as well as the incidental finding of a coronaro-bronchial artery fistula that arose from the left circumflex artery. Percutaneous coronary intervention was performed on the culprit lesion in the left anterior descending artery. A subsequent high-resolution computed tomography of the thorax revealed mild bronchiectic change in the corresponding area supplied by the coronaro-bronchial artery fistula. The patient had a normal lung function test and never had any chest symptoms. From the literature, the association of the coronaro-bronchial artery fistula and localized bronchiectasis is very definite, but the pathophysiology is still controversial.

Aged↗
PubMed1992

[The treatment of bronchiectasis by using left lower lobectomy with extirpation of lingular division of the bronchi].

7 cases with bronchiectasis of left lower lobe and lingular segment were treated with left lower lobectomy and extirpation of the bronchi of lingular segment. Its advantages are that the upper division lung will not be damages, the complication of sigmentectomy be avoided. Meanwhile, the ability of lung expand will be remained and the compensating emphysema were prevented in the survival lung. In addition, the operating indication and method were discussed.

Adult↗