Category Archives: Pulmonary Function : Part 6

Recovery of Viruses Other Than Cytomegalovirus From Bronchoalveolar Lavage Fluid: Herpesvirus

Herpesvirus was the most common virus recovered other than CMV and was isolated from 53 (59 percent) of 90 specimens. In 17 patients, herpesvirus was the only virus isolated. These 17 isolates were typed and 16 isolates were type 1. Herpesvirus type 2 was found in a human immunodeficiency virus (HlV)-infected patient.
The medical records were available for review in 48 patients in whom herpesvirus was isolated from the BAL culture, including 21 with HIV and 27 without HIV (Table 2). The HIV-positive group was significantly younger than the HIV-negative group and had a lower WBC count (p <0.01). Herpesvirus was the only pathogen recovered from 17 patients, including 2 of 21 (10 percent) with HIV infection and 15 of 27 (56 percent) without HIV infection (p <0.01). Most patients with herpesvirus infection had diffuse infiltrates, although some had lobar or clear roentgenograms. Patients with HIV were more likely to undergo BAL for symptoms of cough, fever, and shortness of breath even when the chest roentgenogram was interpreted as normal. Seventy percent of HIV-negative patients were receiving corticosteroids at the time the BAL was performed, in comparison with only one HIV-positive patient (p <0.01). The degree of hypoxemia, as defined by the ratio of the РаОг to the fraction of inspired oxygen was similar between groups. Pneumocystis carinii was isolated from 14 HIV-positive patients with herpesvirus but in none of those without HIV infection. Buy proventil itat on The remainder of potential pathogens cultured from the BAL fluid was similar between the two groups.
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Recovery of Viruses Other Than Cytomegalovirus From Bronchoalveolar Lavage Fluid: Results

Recovery of Viruses Other Than Cytomegalovirus From Bronchoalveolar Lavage Fluid: ResultsStatistics
Means and SDs were determined for continuous variables. The Wilcoxon signed rank test and x2 were used to compare discontinuous variables between groups. A probability value of less than 0.05 was considered significant.
Recovery of Viruses
Between January 1, 1986, and January 1, 1992, 1,199 BAL specimens from 895 patients were submitted for viral culture. A virus was isolated from 615 (51 percent) of these cultures. Cytomegalovirus was isolated from 525 (44 percent) of all BAL specimens submitted and accounted for 88 percent of positive cultures (Table 1) read buy birth control pills online. Ninety (8 percent) of 1,199 BAL cultures grew viruses other than CMV including herpesvirus, rhinovirus, influenza, parainfluenza, adenovirus, enterovirus, and respiratory syncytial virus.
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Recovery of Viruses Other Than Cytomegalovirus From Bronchoalveolar Lavage Fluid: Bronchoalveolar Lavage

The BAL was performed through a fiberoptic bronchoscope as previously described. Briefly, the bronchoscope was advanced and wedged into a distal airway involved by the infiltrate or into the lingula or right middle lobe if diffuse infiltrates were present. After wedging, 120 to 240 ml of sterile, nonbacteriostatic saline solution (0.9 percent sodium chloride) was instilled into the segmental bronchus and immediately withdrawn. The aliquots were pooled. Aliquots of BAL fluid were sent for semiquantitative bacteriologic culture, Legionella pneumophila culture, acid-fast stain, as well as mycobacterial and fungal culture. Cytologic studies were done on aliquots with the Papanicolaou and Grocott-methenamine silver stains.
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Recovery of Viruses Other Than Cytomegalovirus From Bronchoalveolar Lavage Fluid

Recovery of Viruses Other Than Cytomegalovirus From Bronchoalveolar Lavage FluidBronchoscopy with bronchoalveolar lavage (BAL) has been shown to be useful in the evaluation of immunocompromised hosts with pulmonary infiltrates, with the diagnostic yield ranging from 30 to 93 percent. The procedure usually is well tolerated by the patient with a low risk of complications. Bronchoalveolar lavage is useful for diagnosing both infectious and noninfectious etiologies of pulmonary infiltrates.2 If a diagnosis is made with certainty, then the immunocompromised patient may avoid further procedures with inherently higher morbidity and mortality.
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Simultaneous Bilateral Spontaneous Pneumothorax: Conclusion

Simultaneous Bilateral Spontaneous Pneumothorax: ConclusionOf the 286 cases of unilateral pneumothorax seen during the review period, pneumomediastinum and/or subcutaneous emphysema were seen in 17 (6.4 percent), roughly the same proportion as in the SBSP group. One patient in our series with miliary tuberculosis, underwent chest tube placement for what was initially a unilateral spontaneous pneumothorax. She then developed a contralateral pneumothorax together with subcutaneous emphysema. The pathogenic mechanism involved in this case remains unclear, as the most frequent cause of subcutaneous emphysema in patients undergoing intercostal tube drainage is a malfunctioning chest tube. On the other hand, interstitial emphysema, pneumomediastinum, subcutaneous emphysema, and pneumothorax are well-described complications of miliary tuberculosis, which suggests that the barriers to the entry of air into the pulmonary interstitium are particularly fragile in this disease. In keeping with this, the list of the 56 hitherto published SBSP cases (Table 2) shows 3 cases of miliary but only 1 with cavitary tuberculosis. Very rarely defects of the anterior mediastinum have been described, and this would provide an attractive explanation for the simultaneity and bilaterality. To the best of our knowledge, however, this condition has not been reported in association with SBSP and is in any case often combined with other congenital anomalies such as pulmonary aplasia, bronchiectasis, or defects of the diaphragm Reading here buy inhalers online.

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Simultaneous Bilateral Spontaneous Pneumothorax: Analysis

The spectrum of clinical presentations was extremely varied, ranging from no symptoms to cardiopulmonary failure. Pettersson et al report the a young man who suffered only mild dyspnea despite total collapse of both lungs. These observations seem to indicate that, as far as the severity of symptoms is concerned, the presence of tension pneumothorax may be as important as the degree of lung collapse. Most of the patients in our series had chest pain. Dyspnea was present in all cases except one, whose SBSP was an accidental finding. Patients who experienced prolonged suffering due to uncontrollable SBSP invariably had some serious underlying disorder.
The main determinant of prognosis was underlying lung disease. The prognosis was excellent in the five patients with SBSP described herein who had normal lungs or only apical blebs. Four patients in this series died but in none of these was SBSP the main cause of death. Thirteen of the 44 hitherto published cases had lethal outcomes and most of these patients died of SBSP. However, as the dramatic outcome may have prompted some publications, this could be seen as introducing a selection bias in favor of cases with a poor prognosis. Our series suggests that, although potentially lethal, SBSP has a good short-term prognosis even in patients with underlying lung disease. Reading here

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Simultaneous Bilateral Spontaneous Pneumothorax: Discussion

Simultaneous Bilateral Spontaneous Pneumothorax: DiscussionThe 12 patients with SBSP we describe; herein represent 4 percent of all patients with spontaneous pneumothorax seen from 1971 to 1990 at the Kantonsspital St. Gallen. The high percentage may in part be due to the fact that our hospital takes referrals from the whole of northeast Switzerland. As several possible cases of SBSP were excluded from the sample because of insufficient documentation, the true incidence may be even higher. The English, German, and French literature contains descriptions of only 44 adult cases of SBSP in 38 publications. Eleven publications on spontaneous pneumothorax in a total of 1,988 patients report 25 cases of SBSP (1.3 percent; range, 0 to 5.2 percent J. canadianneighborpharmacy.com

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Simultaneous Bilateral Spontaneous Pneumothorax: Results

The clinical data of the 12 patients with SBSP seen at this hospital in the review period are summarized in Table 1. At 28.4 years (range, 17 to 77 years), the mean age of these patients was similar to that of the 286 patients with unilateral spontaneous pneumothorax seen here in the same period (38, range 16 to 86 years). Seven of the 12 were male, which accords with the male predominance (66 percent) among the 56 cases of SBSP so far published (this series included) (Table 2). The sex ratio was similar to that of the patients with unilateral spontaneous pneumothorax seen at this institution in the review period (77 percent male). The clinical presentation varied greatly. Case 1 was asymptomatic, while case 8 presented with a life-threatening condition. The records mention unilateral chest pain in five patients, nonsimultaneous bilateral chest pain in three, dyspnea in ten, and cough in one patient. Four of the 12 patients had among them experienced some 16 pneumothoraces in the 6 to 18 months preceding the advent of SBSP. In eight patients, SBSP was the first instance of pneumothorax. canada health and care mall

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Simultaneous Bilateral Spontaneous Pneumothorax: Methods

Simultaneous Bilateral Spontaneous Pneumothorax: MethodsThe medical literature gives extensive coverage to problems related to unilateral spontaneous pneumothorax and nonsimultaneous bilateral spontaneous pneumothorax. However, little information is available on simultaneous bilateral spontaneous pneumothorax (SBSP). Assuming that the incidence of spontaneous pneumothorax is 9 per 100,ООО and that 1.3 percent of these cases involve bilaterality and simultaneity, we can calculate that in Europe (without the former Soviet Union) there will be 595 and in the United States 324 cases of SBSP per year. We review the special problems of SBSP in terms of epidemiology, clinical presentation, prognosis, pathogenesis, and therapy, based on documented experience from the 12 cases reported herein and previously published cases. Retrospective analysis of the 12 cases we report from this hospital shows that, particularly in cases of secondary SBSP, valuable time was lost through ineffective attempts at therapy. Whenever possible, definitive treatment in the form of surgical pleurectomy should be undertaken without delay.

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Impact of the Incidental Diagnosis of Clinically Unsuspected Central Pulmonary Artery Thromboembolism in Treatment of Critically III Patients: Conclusion

Furthermore, Wittlich et al and Ritto et al emphasized that the TEE diagnosis of central PE may avoid further time-consuming invasive measures to institute therapy without delay. Similar to our series, incidental diagnosis of PE by TEE performed for other reasons has been reported. This report and our study clearly demonstrate and support the well-recognized fact that PE can coexist with other acute cardiopulmonary disorders. The magnitude of these comorbid disorders often leads to the underrecognition of PE. In addition, TEE also provided important anatomic and physiologic information. Eleven of 14 patients had right heart strain indicating that the thromboemboli seen in the pulmonary artery are clinically significant. This finding is similar to that reported by Kasper et al using TTE and Wittlich et al using TEE in patients documented to have PE. This also suggests that in patients presenting with either clinically suspected PE or findings of acute cardiopulmonary disorders, and TTE is not feasible or poor, TEE allows reliable assessment of right ventricular anatomy and physiology. If there is TEE evidence for right heart strain, this increases the suspicion for coexisting PE. Transesophageal echocardiography also demonstrated patent foramen ovale in 3 of 12 patients providing an explanation for hypoxemia (Table 2).
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