Risk factors for lower airway bacterial colonization in chronic bronchitis.
The aim of this study was to determine the prevalence and risk factors for lower airway bacterial colonization (LABC) in stable chronic bronchitis (CB). Forty-one outpatients with CB were enrolled in the study (age 63.8+/-9.1 yrs (mean+/-SD); forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) 62.8+/-11.2; current/former smokers 24/17). All patients had normal chest radiographs and an indication for performing fibreoptic bronchoscopy (pulmonary nodule, remote haemoptysis). The protected specimen brush (PSB) was used for bacterial sampling, and concentrations > or = 1,000 colony-forming units (cfu) x mL(-1) were considered positive for LABC. The repeatability of the procedure in CB was assessed in a random subsample of 18 subjects. A 72.2% quantitative agreement was found in the repeatability assessment of the PSB technique. Positive PSB cultures, obtained in 9 out of 41 (22%) patients, mainly yielded Haemophilus influenzae. The logistic regression model, used to determine which variables were related to colonization, showed that LABC was associated with current smoking (odds ratio (OR) 9.83, confidence interval (CI) 1.16-83.20) and low FVC (OR 0.73, CI 0.65-0.81). Age and FEV1 were not related to LABC. It was concluded that the prevalence of LABC in stable CB is high (22%), and current smoking is an important risk factor. (+info)
Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease.
The aim of this prospective observational study was to determine those factors influencing bacterial colonization in patients with stable chronic obstructive pulmonary disease (COPD). Eighty-eight outpatients with stable COPD and 20 patients with normal spirometry and chest radiography (controls) had a fibreoptic bronchoscopy performed with topical aerosol anaesthesia. Bacterial colonization was determined using the protected specimen brush (PSB) with a cut-off > or = 10(3) colony-forming units (CFU x mL(-1)). The influence of age, degree of airflow obstruction, smoking habit, pack-yrs of smoking, and chest radiographic findings on bacterial colonization were assessed by univariate and multivariate analysis. Significant bacterial growth was found in 40% of patients and in none of the controls. Haemophilus influenzae, Streptococcus viridans, S. pneumoniae and Moraxella catarrhalis were the most frequent pathogens. After adjustment for other variables, severe airflow limitation (odds ratio (OR) 5.11, 95% confidence interval (CI) 1.45-17.9) and current smoking (OR 3.17, 95% CI 2.5-8) remained associated with positive bacterial cultures. When only potentially pathogenic micro-organisms were considered, significant bacterial growth was found in 30.7% of patients, with severe airflow obstruction (OR 9.28, 95% CI 2.19-39.3) being the only variable independently associated with positive bacterial cultures. Our results show that stable chronic obstructive pulmonary disease patients have a high prevalence of bacterial colonization of distal airways which is mainly related to the degree of airflow obstruction and cigarette smoking. (+info)
Broncholithiasis: rare but still present.
Broncholithiasis is a rare but distinct and potentially dangerous pulmonary problem that still needs to be considered in the differential diagnosis of some patients with bronchial obstruction. Broncholiths originate from calcified material in peribronchial lymph nodes eroding into the tracheobronchial tree. The clinical and chest X-ray signs are usually non-specific, but the diagnosis can nowadays be made based on clinical suspicion, CT-scan and fibre-optic bronchoscopy findings, so that a malignant cause of airway obstruction can be ruled out. The removal of broncholiths during fibre-optic bronchoscopy is seldom possible and rather dangerous. They can be removed safely by rigid bronchoscopy with the aid of Nd-YAG laser photocoagulation. Thoracotomy is indicated in complicated cases with fistula formation or severe bleeding. (+info)
Vascularity in asthmatic airways: relation to inhaled steroid dose.
BACKGROUND: There is an increase in vascularity in the asthmatic airway. Although inhaled corticosteroids (ICS) are an effective anti-inflammatory treatment in asthma, there are few data on any effects on structural changes. METHODS: Endobronchial biopsy specimens from seven asthmatic subjects not receiving ICS and 15 receiving 200-1500 microg/day beclomethasone dipropionate (BDP) were immunohistochemically stained with an anti-collagen type IV antibody to outline the endothelial basement membrane of the vessels. These were compared with biopsy tissue from 11 non-asthmatic controls (four atopic and seven non-atopic). RESULTS: There was a significant increase in the density of vessels (number of vessels/mm2 of lamina propria) in the asthmatic subjects not on ICS compared with non-asthmatic controls (mean 485 (interquartile range (IQR) 390-597) versus 329 (IQR 248-376) vessels/mm2, p<0.05; 95% CI for the difference 48 to 286). There was no significant difference between asthmatic subjects on ICS and those not on ICS or control subjects in the number of vessels/mm2 (mean 421 (IQR 281-534)). However, patients who received >/=800 microg/day BDP tended to have a reduced number of vessels/mm2 compared with patients not on ICS and those receiving +info)
Aspirated foreign bodies in the tracheobronchial tree: report of 250 cases.
During the last 14 years, 250 patients with aspirated foreign bodies in the tracheobronchial tree were admitted to Kuwait Chest Diseases Hospital. Ninety-six per cent of the cases were under 10 years of age and 38% gave a clear history of foreign body inhalation. The rest were diagnosed either clinically, from the chest radiograph findings or because of unexplained pulmonary symptoms. In 247 cases, bronchoscopy under general anaesthesia was successful in removing the foreign bodies. In only three cases was bronchotomy needed. Seventy per cent of the foreign bodies were melon seeds. Asphyxia and cardiac arrest occurred in four cases during bronchoscopy but the patients were successfully resuscitated. In 10 cases a tracheostomy was done before bronchoscopy and the removal of the foreign body, while in five it was needed after bronchoscopy. Fifteen patients developed late complications such as recurrent pneumonia or atelectasis of the lung. Early diagnosis and adequate treatment are essential to prevent pulmonary and cardiac complications and to avoid radical lung surgery. (+info)
Diagnostic value of endoscopic ultrasonography-guided fine-needle aspiration cytology of mediastinal masses in patients with intrapulmonary lesions and nondiagnostic bronchoscopy.
Several procedures are available for the cytopathological diagnosis of mediastinal lesions. The purpose of this study was to evaluate the diagnostic value of endoscopic ultrasonography (EUS)-guided fine-needle aspiration (FNA) in patients with mediastinal mass lesions/lymph node enlargement. All patients had intrapulmonary lesions on chest X ray and/or CT scan, and inconclusive findings by endobronchial forceps biopsy and/or brush cytology. EUS-guided FNA was performed in 16 patients using a modified oblique forward-viewing gastroscope with an electronic multielement curved linear ultrasound transducer. After the region of interest was localized, a 22-gauge Vilmann-Hancke needle was introduced via the 2-mm biopsy channel. The cytological diagnosis of EUS-guided FNA was conclusive for cancer in 9 patients and in the other 7 patients the aspirated samples revealed a benign lesion. In 10 patients the final diagnosis was cancer, thus EUS-guided FNA was diagnostic for malignancy in all but 1 of the lesions (sensitivity 90.0%). In 1 patient epitheloid cell granuloma was detected by cytological examination of the FNA. Following tuberculostatic treatment the lesions disappeared completely on CT scan and EUS. The overall accuracy in this study amounted to 93.7%. From this and other studies discussed, it is assumed that the procedure is an accurate and safe technique to examine nodular lesions suggestive of metastatic lymph node involvement. (+info)
Forced expiratory wheezes in a patient with dynamic expiratory narrowing of central airways and an oscillating pattern of the flow-volume curve.
Forced expiratory wheezes (FEW) are common and the pathogenesis of this phenomenon might involve fluttering of the airways, but this theory has not been confirmed in patients. We report a case of a patient with FEW and a normal FEV1 that showed a bronchoscopically confirmed collapse of the trachea and main stem bronchi during forced expiration. Superimposed to the flow-volume curve was an oscillating pattern with a frequency that corresponded well with the wheeze generated during forced expiration. The oscillating pattern in the flow-volume curve and the collapse of the major airways supports the theory of wheezes generated by fluttering airways during forced expiration. Although FEW may be found also in healthy subjects, flow limitation is essential for the generation of FEW. The inclusion of a forced expiratory maneuver in the clinical examination might therefore be helpful in guiding the diagnosis towards airways obstruction. (+info)
A man with a prosthetic ear and multiple pulmonary nodules.
Basal cell carcinoma is generally regarded as a relatively indolent tumor easily controlled with local therapy. When neglected or inadequately treated this tumor can become locally aggressive and in rare circumstances metastasize. This report documents a case of basal cell carcinoma metastatic to the lung that resulted in rapidly progressive respiratory failure and death. (+info)