Liver transplantation for primary and metastatic liver cancers

Halotherapy was used for sanatorium rehabilitation in 29 patients with chronic obstructive pulmonary diseases (chronic bronchitis and asthma). Significant positive effects of this method resulted in the improvement of the flow-volume parameters curve of lung function and in hypotensive effects on blood pressure. Halotherapy is recommended for use in patients suffering from chronic obstructive pulmonary diseases with hypertension or coronary heart disease.     

The effect of alpha-tocopherol and beta-carotene supplementation on COPD symptoms

The effects of alpha-tocopherol (50 mg/d) and beta-carotene (20 mg/d) supplementation on symptoms of chronic obstructive pulmonary disease were studied among the 29,133 participants of the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study undertaken to investigate the effects of these two substances in the prevention of lung and other cancers. During the follow-up the supplementations did not affect the recurrence or incidence of chronic cough, phlegm, or dyspnea. The prevalence of chronic bronchitis and dyspnea at baseline was lower among those with high dietary intake of beta-carotene (OR = 0.78 and 0.67, respectively) or vitamin E (OR = 0.87 and 0.77) and high serum beta-carotene (OR = 0.59 and 0.62) and alpha-tocopherol (OR = 0.76 and 0.82). High intake and serum levels of retinol were associated with low prevalence of dyspnea (OR = 0.84 and 0.80, respectively) but not with chronic bronchitis. The results indicate no benefit from supplementation with alpha-tocopherol or beta-carotene on the symptoms of chronic obstructive pulmonary disorders but support the beneficial effect of dietary intake of fruits and vegetables rich in these compounds.     

The use of a pulsed traveling magnetic field in patients with chronic obstructive bronchitis

A course treatment with pulse running magnetic field generated by ALIMP-1 unit of patients with chronic obstructive bronchitis provides a subjective response, higher exercise tolerance due to improved function of the external respiration. The inductors-solenoids are fixed tangentially on the chest by means of the jacket.     

Treatment of patients with pneumonia, chronic obstructive bronchitis and mucoviscidosis with cefpirome

Twenty two patients with inflammatory respiratory tract infection were treated with cefpirome. Among the patients 14 were with severe pneumonia, 4 with exacerbated obstructive chronic purulent bronchitis and 4 with mucoviscidosis. All the patients were subjected to clinical, laboratory and x-ray examinations, electrocardiography, estimation of the external respiration and sputum bacteriological tests. The cefpirome susceptibility was determined by the agar diffusion assay with standard disks from Roussel Uclaf. Cefpirome was administered by slow intravenous infusion in a daily dose of 2 to 4 g every 12 hours depending on the disease severity. After 2 or 3 days of the patient afebrile temperature and normal differential blood count the therapy was discontinued. The favourable time course of the disease was recorded in 12 out of the 14 patients with pneumonia. Recovery and clinical improvement were stated in 64.3 and 21.4 per cent of the cases respectively. In 2 patients the treatment failed. In all the patients with exacerbated severe chronic purulent bronchitis the cefpirome therapy resulted in the disease remission. The clinical effect of the mucoviscidosis treatment was observed in 3 out of the 4 patients. The drug tolerance in the doses used was good.     

Varicella pneumonia in the adult. A review of 25 cases

OBJECTIVE: To study the clinical, therapeutic, and evolutive features in 25 patients with the diagnosis of varicella pneumonia (VP) in the last 15 years. PATIENTS AND METHODS: The diagnosis was established by clinical and radiologic criteria in the course of varicella infection. The antecedents of smoking habit, pregnancy, and underlying disease were evaluated. Hypoxemia was defined as a pO2 < or = 65 mmHg with a FiO2 of 0.21. RESULTS: Twenty-five patients (16 males and 9 women; mean age 31.5 years, range: 24-43 years) were included in the study. Ninety-two percent of patients were smokers of more than 20 cigarettes a day; five met criteria of simple chronic bronchitis, 3 were known carriers of human immunodeficiency virus (HIV) and one had a chronic liver disease caused by hepatitis C virus. In 16 patients (64%) there were no underlying diseases and none of the female patients was pregnant. Respiratory symptoms began from the first and seventh day after the skin rash, and the most common symptoms were cough (76%), dyspnea (48%), and chest pain (44%). In 22 patients an arterial gas determination was obtained and hypoxemia was documented in 8 patients (32%). Hypoxemia was greater and statistically significant in patients with underlying diseases (p < 0.01). Chest X-ray revealed an interstitial pattern predominantly at both bases. Intravenous acyclovir therapy was started in 19 patients (76%) with severe respiratory symptoms and/or underlying disease. Three patients (12%) were admitted to the Intensive Care Unit for mechanical ventilation. All patients had a favourable clinical course. CONCLUSIONS: Adult patients with symptoms of VP had a favourable clinical course with intravenous acyclovir, and the presence of hypoxemia was more commonly observed when underlying diseases were also present.     

The characteristics of the clinical manifestations and treatment of chronic obstructive bronchitis in patients with hepatobiliary system diseases and pseudoallergy

Routine clinical, laboratory, instrumental and immunological examinations in 105 patients have established that hepatobiliary disorders occur 2.2 times more frequently in patients with chronic obstructive bronchitis (COB) and pseudoallergy than in those without pseudoallergy. To correct negative effects of pseudoallergy, conventional therapy was combined with enterosorbent polyphepan, spasmolytic nospa and cholagogic allochol used alone or in different combinations. The highest benefit for COB patients was achieved in using combination of polyphepan + nospa + allochol.     

A comparative evaluation of the efficacy of the conservative treatment of chronic apical periodontitis in patients with secondary immune deficiency and in somatically healthy persons

The efficacy of conservative treatment of chronic apical periodontitis is compared is somatic patients and somatically healthy subjects. Twenty-seven patients with chronic obstructive bronchitis and secondary immune insufficiency and 31 patients without underlying diseases were treated. Conservative treatment of chronic apical periodontitis was insufficient in the patients with secondary immunodeficiency.     

Bronchial inflammation in chronic bronchitis assessed by measurement of cell products in bronchial lavage fluid

BACKGROUND: Bronchial inflammation in chronic bronchitis has not been characterised as well as in asthma. The present study was undertaken to assess whether a characteristic pattern of bronchial inflammatory markers could be found in patients with chronic bronchitis. METHODS: Bronchoscopy with bronchial lavage was performed in 42 patients with chronic bronchitis and in 13 healthy controls. Twenty three of the patients had non-obstructive chronic bronchitis and 19 had chronic bronchitis and chronic obstructive pulmonary disease (COPD). Eighteen of the patients with bronchitis had recurrent infective exacerbations and 24 did not. Intrabronchial bacterial cultures were taken with a protected specimen brush. RESULTS: Increased activity of neutrophils, fibroblasts, and eosinophils was found in the patients with chronic bronchitis as assessed by the levels of myeloperoxidase (MPO) and interleukin-8 (IL-8), hyaluronan, and eosinophil cationic protein (ECP), respectively. The levels of tryptase did not differ from the controls. High correlations were found between the levels of MPO and IL-8, as well as ECP and IL-8. No differences were found between the patients with COPD and those with non-obstructive chronic bronchitis. CONCLUSIONS: Recruitment and activation of both neutrophils and eosinophils seem to be a characteristic of chronic bronchitis. This activation is associated with IL-8. The patients with intrabronchial cultures of Streptococcus pneumoniae had the highest individual levels of MPO, ECP, and IL-8 of all subjects in the study, indicating that colonisation with S pneumoniae could promote bronchial inflammation.     

The NADPH-diaphorase activity of the bronchial epithelium in chronic lung diseases

Topochemistry and activity of NADP-H diaphorase co-localized with NO synthase was examined in operative material of lungs from patients with bronchial asthma (BA), chronic nonobstructive bronchitis (CNO) and chronic obstructive bronchitis. The enzyme activity was found to be dependent upon the types of obstruction and inflammation. In CNO the state of NO synthase was not changed. In conditions of progressive irreversible airway obstruction the enzyme activity was augmented in small bronchi epithelium and alveolar macrophages (AM). In reversible obstruction the activity of NO synthase was not changed in the epithelium but appeared high in resident cells of inflammation--AM and mast cells.     

Common misunderstandings about complementary therapies for patients with cancer

This study aimed at clarification of pathophysiological mechanisms underlying bronchial obstruction in 28 18-71-year-old patients with chronic bronchitis (CB) diagnosed 2-8 years before. The patients had moderate obstructive disorders in distal parts of the bronchial tree. Investigations revealed a group of patients with paradoxical response to beta-blockers manifesting as lowering of bronchial resistance and high speed. Bronchial obstruction in these patients proved to arise primarily from early expiratory collapse of small bronchi. Administration of beta-mimetic and beta-blocking agents may serve as pharmacological tests able to discover mechanisms of bronchial obstruction and help in the choice of adequate therapy for chronic bronchitis.     

Equine alopecia areata autoantibodies target multiple hair follicle antigens and may alter hair growth. A preliminary study

The efficacy and safety of a five-day course of cefuroxime axetil (250 mg b.d.) and a seven-day course of clarithromycin (250 mg b.d.) were compared in a large double-blind, randomised, multinational study involving 684 patients with acute exacerbations of chronic bronchitis. In an intent-to-treat analysis, the post-treatment clinical responses to each treatment were comparable (82%) and rates at follow-up were similar: 64% on cefuroxime axetil and 61% on clarithromycin. Pre-treatment pathogens were isolated from a total of 192 patients, Haemophilus influenzae being the most common. Overall pathogen eradication rates were similar for both treatments. Both treatments were well tolerated. In conclusion, a five-day course of cefuroxime axetil is clinically equivalent to a seven-day course of clarithromycin in the treatment of acute exacerbations of chronic bronchitis, and may have potential socioeconomic benefits.     

Pulmonary thromboembolism

Pulmonary embolism (PE) is a serious complication of chronic obstructive pulmonary disease (COPD). Retrospective studies on patients with COPD treated in the intensive care unit (ICU) were performed to determine: 1) the frequency of PE; 2) the clinical course of PE in cases of COPD in the ICU; and 3) the frequency of PE as a cause of death in the studied group. The frequency of PE was 10.9% in COPD patients. In the group analysed, clinical presentation of PE was characterized by acute severe, life-threatening complications leading to death in 86.7% of cases. PE was the most frequent cause of death (40.6%) in COPD patients in the ICU. The results of treatment of pulmonary embolism in chronic obstructive pulmonary disease are poor and mortality in this group of patients is very high. We believe that improvement of management can be achieved by antithromboembolic prophylaxis, which should be instituted as soon as possible in all patients with chronic obstructive pulmonary disease in the intensive care unit.     

Diagnosis of emphysema in patients with chronic bronchitis: a new approach

Aerosol-derived airway morphometry (ADAM) and aerosol bolus dispersion (D) are altered in patients or animal models with lung emphysema. This study was performed to examine the sensitivity and specificity of ADAM and D in the detection of emphysema in vivo compared with conventional lung function parameters. The study comprised patients with chronic obstructive bronchitis (COB) without emphysema (group COB; n=19, age 56+/-8 yrs, forced expiratory volume in one second (FEV1)/vital capacity (VC) 66+/-12% predicted) and patients with chronic bronchitis with high-resolution computed tomography-confirmed emphysema (group COB-E; n=20), age 65+/-7 yrs, FEV1/VC 44+/-16% pred). Using monodisperse aerosol particles ADAM assessed the calibres of peripheral airspaces, while D measured convective gas mixing. Among all lung function parameters, ADAM and D showed the highest sensitivity and specificity for separating patients with COB from those with COB-E (area under the receiver operating characteristics curve (pROC) 0.99 and 1.0, respectively). In patients with COB aerosol parameters did not differ from those found in the control group, whereas patients with COB-E exhibited a two-fold increase in peripheral airspace dimensions compared with subjects with COB (0.86+/-0.07 versus 0.37+/-0.02 mm, p=0.0001) and an increase in D by >50% (541+/-74 versus 345+/-42 cm3, p=0.0001). In conclusion, aerosol-derived airway morphometry and aerosol bolus dispersion are powerful tools in the differential diagnosis of chronic obstructive pulmonary disease.     

Value and costs of pulmonary rehabilitation

Pulmonary rehabilitation (PR) is nowadays a recognized discipline for stabilisation and improvement of chronic pulmonary diseases. According to epidemiologic data the number of patients with chronic obstructive bronchitis and asthma is on the rise. Aim and components of a modern stationary PR-program are defined and benefit and costs discussed according to data from recent publications. Necessity of an individual, stepwise, multidisciplinary and holistic approach to physical and psychic symptoms based on an exact diagnostic workup is shown. Data from selected studies on benefits of PR such as reduced frequency and/or cost of hospitalisations, improved quality of life or reduced symptoms, improvement of pulmonary function and effects on mortality and working capacity are discussed. Since controlled studies are unavailable from Switzerland so far, data from American and European literature are used. In the most severe terminal stages of pulmonary failure individual complementary surgical measures have to be evaluated, i.e. volume-reducing surgery for emphysema or transplantation of the lung. The peri- and postoperative risks and arising costs have to be weighted against the expected improvement of pulmonary function and quality of life by exhaustive conservative measures.     

A comparative assessment of the clinical efficacy of standard and low-volume plasmapheresis in treating patients with bronchial asthma and chronic bronchitis

21 patients with bronchial asthma and chronic obstructive bronchitis resistant to standard therapy have been exposed to discrete plasmapheresis. Changes in the bronchial tree inflammation measured by fibre bronchoscopy and activity of neuron-specific enolase (NSE) in bronchial wash-offs made it clear that low-volume plasmapheresis is not inferior in efficacy to the standard method. The trend in the fall of NSE activity as a marker of diffuse neuroendocrine system objectively reflects attenuating inflammation in bronchial mucosa in response to treatment of chronic obstructive diseases of the lungs using different techniques of plasmapheresis.     

Chronic obstructive pulmonary disease stage and health-related quality of life. The Quality of Life of Chronic Obstructive Pulmonary Disease Study Group

BACKGROUND: The American Thoracic Society recently recommended that chronic obstructive pulmonary disease be staged on the basis of the percentage of predicted FEV1. OBJECTIVE: To examine 1) the relation between the american Thoracic Society system for staging chronic obstructive pulmonary disease and health-related quality of life and 2) the effect of self-reported comorbid conditions on health-related quality of life. DESIGN: Cross-sectional study. SETTING: Outpatient clinics of respiratory departments of four hospitals and one primary health care center in spain. PATIENTS: 321 consecutive male patients with chronic obstructive pulmonary disease. MEASUREMENTS: Functional respiratory impairment, FEV1, respiratory symptoms, and health-related quality of life. Respiratory symptoms and health-related quality of life were measured by using the Spanish version of the St. George's Respiratory Questionnaire and the Nottingham Health Profile. RESULTS: Patient scores on the St. George's Respiratory Questionnaire were moderately to strongly associated with disease staging (r = 0.27 to 0.51). Compared with reference values, values for health-related quality of life for patients with stage I disease were substantially higher on the St. George's Respiratory Questionnaire (6 and 34; p < 0.001) and values for impairment were significantly greater in stage 1 patients with comorbid conditions (19 and 36; P = 0.001). At least one concomitant chronic condition was found in 84% of study patients. Comorbid conditions only partly influenced the observed pattern of deterioration of health-related quality of life with worsening stages of disease. CONCLUSION: Staging criteria for chronic obstructive pulmonary disease based on percentage of predicted FEV1 separated groups of patients with varying degrees of impairment in health-related quality of life. Contrary to expectations, even patients with mild disease showed substantially compromised health-related quality of life. Comorbid conditions influenced the relation between chronic obstructive pulmonary disease and health-related quality of life.     

Acute obstructive renal failure. Analysis of 28 cases

This retrospective study is concerned 28 patients hospitalized with acute obstructive renal failure at the department of nephrology in UHC Ibn-Rochd between 1988 and 1995. The objective of this study was to determine the clinical, étiological, therapeutical and evolutive aspects of the acute obstructive renal failure. It concerned 21 men and 7 women, their mean age is 52 years old. The main symptoms were anuria (85%) and lumbar pain (75%), the mean delay of consultation was 42 days. The diagnosis of the acute obstructive renal function and the presence of obstacle on the upper urinary tract. The obstacle was a stone in 19 cases, cancer in 8 cases and one case of retroperitoneal fibrosis was noted. Treatment of the cause was done whenever possible. Treatment was often palliative in the tumoral pathology. We observed 3 deaths (10.5%), 16 recoveries (58%), 6 cases of residual renal failure (21%), 3 cases of terminal chronic renal failure (10.5%) and 4 cases of recurrence. The lithiasic etiology of acute obstructive renal failure led to a high short-term mortality (15.5%), an effective etiologic causative treatment (69.5%) and a high rate or restoration of the renal function (69.5%). On the other hand, in the neoplastic etiology, there were no short-term mortality, but a frequent course to chronic renal failure.     

The characteristics of disorders of intracardiac hemodynamics and hemorheology in pulmonary heart failure

Overall ninety patients with chronic obstructive bronchitis presenting with signs of varying degree cardiopulmonary insufficiency (CPI) were evaluated by radionuclide ventriculography with technetium pertechnetate as well as by rotational viscosimetry of blood. The degree of hemorheological derangements tended to get higher with CPI severity (light, moderately severe, severe) being accompanied by progressing impairement of systolic and diastolic functions of both ventricles of the heart. Mechanisms of compensation of endocardiac hemodynamics were realized as a result of increase in end-diastolic and end-systolic volumes of both ventricles together with changes in amplitude and time characteristics of processes of ventricular ejection and filling. Forecast of the probable course of the condition may rely upon the functional state of right as well as left ventricle of the heart.     

Canine filarial infections in north Taiwan

STUDY OBJECTIVES: Define the incidence of obstructive atelectasis in patients presenting with small cell lung cancer and their response to treatment. DESIGN: Retrospective review of clinical records and radiographic studies. SETTING: Single federal government institution-the National Cancer Institute-Naval Medical Oncology Branch. PATIENTS: One hundred seventy-two consecutive patients treated between 1983 and 1993. INTERVENTIONS: Patients presenting with obstructive atelectasis were identified. The incidence of dyspnea, cough, and sputum production before starting treatment and 1, 3, and 6 months later was determined. Fiberoptic bronchoscopy and chest radiographs performed before starting treatment were compared with those obtained later in the patients' clinical course. MEASUREMENTS AND RESULTS: Thirty-seven of 172 (22%) patients had obstructive atelectasis. Initial symptoms included cough in 25 (68%), dyspnea in 24 (65%), and productive cough in 10 (27%). The patients' symptoms of cough, dyspnea, and sputum production decreased to one third of the initial prevalence 1 month after the start of treatment. Fiberoptic bronchoscopy and chest radiographs performed 3 months after starting treatment demonstrated bronchial patency in 90%. CONCLUSIONS: Obstructive atelectasis occurs in approximately one fifth of patients presenting with small cell lung cancer. Chemotherapy and chemotherapy plus chest radiotherapy lead to symptomatic, bronchoscopic, and radiographic resolution in similar proportions of patients with obstructive atelectasis.