A case report is presented of a man with pronounced tracheobronchomegaly who has had respiratory symptoms since childhood. In spite of numerous medical examinations a disease remains undetected for many years. Authors bring up different standpoints about etiology and the most often accepted hypothesis about the autosomal recessive inheritance. They also point their attention to a small number of diagnosed cases despite high prevalence (0,4-1%) and typical symptoms.
Historical perspectives, incidence, clinical presentation, immunopathogenesis, aspirin challenge and sulfiting provocation test are presented together with the hyposensitization, complications, diagnosis and differential diagnosis and treatment of these forms of bronchial asthma. Many patients with aspirin bronchial asthma can tolerate acetaminophen. Over 90% of patients with allergic bronchopulmonary aspergillosis have extrinsic form of bronchial asthma. Criteria for the diagnosis of allergic bronchopulmonary aspergillosis are described. About 5-10 percent of all asthmatic patients may have some degree of sulfite sensitivity. The principle of etiologic differentiation is reasonable when the therapy is indicated by confirmed bronchial asthma. In some cases the invasive methods of diagnostics should be applied (provocation, BAL, transbronchial biopsy, transthoracic biopsy).
This study was designed to determine the contribution of diaphragm dysfunction and pain to respiratory insufficiency after upper abdominal surgery. Respiratory insufficiency and postoperative pain in humans were evaluated by pulse oximetry, pulmonary function tests, and a visual analog scale. Diaphragm shortening in dogs was evaluated with biplane videoroentgenography. In humans, despite reasonable pain control, pulmonary function, as reflected in forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and arterial oxygen saturation (SpO2) were significantly reduced on the first postoperative day. Improved pain control was not associated with improvements in FVC or FEV1. In the dogs, diaphragm shortening and tidal volume were significantly reduced in the immediate postoperative period. Phrenic nerve stimulation immediately after surgery resulted in supramaximal diaphragm shortening, which indicated neither the diaphragm nor phrenic nerves were significantly injured by surgical manipulation. Diaphragm dysfunction has a major role in postoperative pulmonary insufficiency; an afferent-mediated reflex inhibition of the phrenic nerves may be responsible.
Bronchial asthma and methemoglobinemia due to the allergy on milk was described in 34-year old man. Very marked cyanosis with 15.3% methemoglobin, E--7.2, 272% hemoglobin, 52% hematocrit, severe form of bronchial asthma with PaO2--7.63 kPa, 89% saturation, PaCO2--4.46 kPa were found. Sternal and bone biopsy showed myeloproliferative disease. Allergy testing showed positive early and late reaction on milk. Serum IgE was 1670 mu/ml, RAST and precipitin test were positive on milk. Bronchoprovocation test on milk showed positive asthmatic reaction. After elimination of milk products from food all findings were soon normalised and the patient has not had bronchial asthma and cyanosis for two years now.
The paper gives a case report of the primary malignant melanoma of the trachea in a 61 years old patient with micrometastasis in the right upper lobe of the lung. The diagnosis was made after autopsy. Macroscopically, a polypoid, greyish, partly dark brown tumor was found 6 cm above the tracheal bifurcation on the site of connection between the membranous and cartilaginous part. The tumor was fixed to the trachea wall with a very narrow long stalk, causing long dispnoic attacks worsening in a back lying position particularly. Histologically, both the primary tumor and its secondary deposit in the right lobe were found to have similar appearance as a malignant melanoma elsewhere. Melanin pigment was found in abundance here and there and easily detected already in preparations stained by the hematoxylin--eosin method. The large polypoid tumor caused an obstruction of the trachea and finally suffocation.
The effect of vitamin C on exercise-induced airway constriction was studied. Pretreatment with ascorbic acid prevented the significant alteration in airway geometry induced by exercise asthmatic patients. These results suggest that vitamin C deficiency might augment airway responses to exercise and other bronchospasmogenic factors, and treatment with vitamin C may decrease airway hyperresponsiveness.
Allergenic activity of allergen extract Ambrosia elatior (AE) was tested in fifteen volunteers extremely sensitive to the allergen. The research was performed by using the quantitative prick (P) and the intradermal (ID) test. The results were analyzed by the parallel line assay method. Allergenic activity of the specimen was estimated: by the number of the allergen units (AU) in 1 ml of the undiluted specimen according to the results of the P (prick) test; by the number of the allergen units (AU) in 1 ml of the undiluted specimen according to the results of the I. D. test, and by the in vitro standardized method of the RAST inhibition. These preliminary results show that allergen extract Ambrosio elatior has 100,000-130,000 Bu/ml and ca 1000 AU/ml while allergenic activity of the extract measured by the RAST inhibition method has ca 57,000 IU/ml.
Investigations were performed on 20 patients with mild and moderately severe forms of bronchiale asthma or chronic obstructive bronchitis. Theophylline for oral use (sustained release form) and Ranitidine (second generation H2-blocker) were used in the first group of patients (7 females and 3 males, average age 37.9). Dosage of theophylline from patients sera was monitored at 3, 6 and 12 hours, beginning with the initial morning dose. The second group of patients (9 females and 1 male, average age 46.3) were on Ranitidine therapy, along with 250 mg intravenous theophylline-ethylene-diamine. Fractionated dosage of theophylline was done within 12 hours. Pharmacokinetic parameters were calculated according to the concentration of theophylline in the sera of patients in the second group. Significant differences were not found by statistical analysis (T-test) in the pharmacokinetic parameters of theophylline although significantly higher concentrations of theophylline were found in the sera of patients in the first group. This indicated that there are individual differences on the metabolism of theophylline drugs with concomitant use of Ranitidine.
A patient with symptoms of coronary artery disease is presented. ECG changes, chest X-ray, echocardiography as well as ventilation-perfusion study excluded coronary artery disease and confirmed cor pulmonare chronicum and pulmonary hypertension. Patophysiological aspects and clinical symptoms are also discussed.
The authors report on 29 cases of intrathoracic localization of extramedullary hematopoiesis. Out of them, 26 cases were confirmed by cytomorphologic examination of the aspirate specimens obtained by transtracheal biopsy of carina while in 3 cases the specimens for cytologic analysis were obtained by transthoracic fine needle aspiration of solitary shadows in the lung parenchyma. The cytomorphologic finding of the hematopoietic cells of the specimens obtained by transtracheal biopsy was unexpected in patients with an active pulmonary tuberculosis, primary bronchial carcinoma, broncho and pleuropneumonia, lung abscess, sarcoidosis, chronic bronchitis, rheumatoid arthritis as well as in patients with hemoptysis.
In 20 patients with chronic obstructive pulmonary disease (COPD) the effects of inhalation of Bisolvon (BS) were compared with the inhalations of thermomineral water of the well MT.6 of thermal spring Moravci (TMW). It was found that mean maximal expiratory flow during inhalations of TMW was statistically significantly higher from that during inhalation of BS (P less than 0.05). By visually-analogous scale the patients during inhalations of TMW were found to have statistically smaller dyspnea (P less than 0.001) and after inhalation of TMW they could expectorate much better (P less than 0.01) in comparison with the period of inhalations with BS. The authors consider the inhalations of TMW to be a good method of therapy of patients with COPD.
The study represents the investigation on pharmacodynamic lung function testing in 40 patients (21 with extrinsic asthma and 19 with intrinsic asthma). Skin prick tests on common inhalation allergens, IgE antibodies, spirometry, flow-volume curve, body plethysmography and pharmacodynamic testing with salbutamol spray were performed in each person. The greatest changes after beta 2 agonist were established by plethysmographic parameters SGaw (mean increase 117%) and Raw (mean decrease 45%), than by the expiratory flow rates from flow-volume curve: FEF25%-75% and FEF50% (mean increase 26%), than the FEV1 (+ 15%), the PEF (also + 15%), the RV (mean decrease 17%) and the FVC (mean increase 8%). The aim of this study was to represent the necessity of the complex analysis and interpretation of the results of pharmacodynamic testings because of many factors that might change the values of the tests.
The functional parameters Raw, Rrs, FEV1, RV, FEF25 and FEF50 have been examined in 1000 patients with bronchial obstruction. Measurement of airway resistance is the precise examination for bronchial obstruction. For the routine clinical examination the interruptional measurement of Rrs is sufficient (correlation test + 0.56). Resistance may be measured indirectly by dynamic pulmonary volume testing (correlation FEV1: Raw = -0.55; FEF50: Raw = -0.63).
A 54-yr old male patient with a history of dyspnea and cough is presented. Due to the clinical course of disease and the radiological changes in the chest a diagnosis of sarcoidosis was established. However, the open lung biopsy revealed the true nature of the pulmonary disease: pulmonary adiaspiromycosis, only secondary to asbestosis, siderosis and silicosis as due to the well known occupational exposure to asbestos and other dusts.
The analysis comprised 23 patients with planocellular bronchial carcinoma in whom monoradiotherapy was used. Stage III dominated in the studied group (56.6%). Positive response to therapy was achieved in 60.9% of the patients. The effect was maintained for 9 months and after that the disease continued to progress. In 17.4% of the patients the findings remained unchanged, while in 21.7% uninterrupted progression of the disease was noted. Therapeutical doses of 45 Gy and 60 Gy were applied in 52.2% and 47.8% patients, respectively. Survival of one year was achieved in 26.1% while 4.3% survived for two years. Advanced stage of the disease dominating in the studied group could be the reason for the low survival rate. The results presented as well as the referential ones suggest the better response to therapy and longer survival of patients with planocellular bronchial carcinoma in whom higher therapeutical irradiation dose was applied (60 Gy).
The control of symptoms in patients with allergic rhinitis and bronchial asthma can not be always attained with hyposensitization. This may be achieved with more success with additional treatment with H1 antagonists of histamine receptors. By hyposensitization statistically significant decrease of the total IgE was achieved. Contrary to this, in cases in which the symptoms could not be controlled with hyposensitization, only antihistamines were additionally administered, no significant decrease of IgE took place. These were, probably, more severe cases in which the symptoms could not be controlled with the hyposensitization only. No significant effect on the values of blood eosinophiles was registered with hyposensitization or additional administration of antihistamines.
The study from the working environment prevailing in two departments of tobacco factory (DIN) Nis together with the study of the employees (95) working in these departments were carried out. The workers were divided into two sub-groups: smokers (62) and non-smokers (33) and the results of the lung function tests were compared to normal values. The results found point out to the presence of the tobacco dust in these departments and the values exceeding MAC might have caused the obstructive changes of airways in the workers exposed.
The roentgenologic characteristics of bronchopulmonary carcinoma were studied in 578 patients in whom the disease had been diagnosed by bronchoscopy and confirmed by cytopathologic finding. Each of the pulmonary disease may imitate bronchopulmonary carcinoma and vice versa. Since there is no roentgenologic patognomonic sign for bronchopulmonary carcinoma the sorts and distribution of characteristic X-ray signs were examined. In our group of patients in 67% of cases the right side was involved. The leading point in X-ray was in 52.8% of cases the pathologically enlarged hilus unilaterally and bilaterally. In patients with periphery located bronchopulmonary carcinoma the most frequent X-ray sign was unclearly limited shadow in 41.3% of cases. In patients with centrally located bronchopulmonary carcinoma in 6.4% of cases the normal X-ray sign was found. However, in none of 177 patients with periphery bronchopulmonary carcinoma the normal X-ray was found.
Two groups of patients with chronic pulmonary tuberculosis are presented. The first group of 92 patients were unsuccessfully treated according to current principles of treatment of chronic, resistant pulmonary tuberculosis. In the second group of 11 patients, unsuccessfully treated according to current methods, a new combination of drugs was applied so that a drug of the aminoglycoside group or chinolon group (Amikacin 1000 mg every second day or Ciprofloxacin 750 mg daily) was added to conventional therapy. Applying such therapy during 4 months encouraging results have been obtained.
Respiratory function tests were performed in 110 workers who were occupationally exposed to asbestos-cement dust in the period from 7 to 34 years. Due to the results obtained, the following groups of patients were analysed according to years of asbestos-cement exposure and the habit of cigarette smoking. The analysis of the years of exposure to asbestos-cement dust revealed that the workers with the exposure longer than 16 years had significantly lower FVC and FEV1 (P less than 0.001) than the workers whose exposure was less than 16 years. In view of increasing age this deterioration proved to be significantly higher than it had been expected. Of all the subjects included in this study 7% of them were found to have a partial respiratory insufficiency. The phenomenon could not be explained either by the length of exposure or by the habit of cigarette smoking. In the smoking subjects with the longest exposure, a markedly lower SaHbO2 was found as compared to the smokers with the shortest exposure (P less than 0.05).
