Survival and pulmonary hemodynamics in patients with sequelae of pulmonary tuberculosis who received home oxygen therapy

The pineal organ possesses highly fenestrated capillaries, and is devoid of the so-called blood-brain barrier. The present study indicated that the pineal epithelium of the teleost fish, ayu Plecoglossus altivelis, possesses an unusually thick and convoluted basement membrane (2.2-2.4 microm in width) which is visible even under the light microscope. This pineal basement membrane was observed by scanning and transmission electron microscopy and its detailed composition and relationships with the fenestrated capillaries and the perivascular space were investigated. As the basement membrane was composed of three to eight layers of basal laminae interspersed with laminae lucidae, we termed it the "multilayered basement membrane". In consideration of our previous demonstration that macromolecules such as HRP are trapped by the basement membrane, it is suggested that this multilayered basement membrane may prevent foreign substances from reaching the pineal epithelium.     

Ventilatory and cardiovascular responses to inspired He-O2 during exercise in chronic obstructive pulmonary disease

Blunted maximum cardiac output and systemic O2 extraction could constitute primary limits to exercise in severe chronic obstructive pulmonary disease (COPD) or they could simply reflect cessation of exercise because of abnormal pulmonary mechanics. To determine which is the case, eight consecutive patients with severe COPD (FEV1 = 0. 56 +/- 0.04 L, mean +/- SEM), five of whom had alpha1-antiprotease deficiency, performed two incremental cycling tests while breathing N2-O2 or He-O2. Expired gases and V E were measured, and radial and pulmonary arterial blood was simultaneously sampled each minute. Peak exercise V E was higher with He-O2 than with N2-O2 (25.5 +/- 2. 2 versus 19.3 +/- 1.5 L/min, p = 0.002) and PaCO2 was lower (42 +/- 2 versus 46 +/- 2 mm Hg, p = 0.0003). V O2max improved only modestly (594 +/- 75 versus 514 +/- 54 ml/min, p = 0.04), and was accompanied by an increase in peak exercise CaO2 (18.7 +/- 0.9 versus 17.6 +/- 0. 9 ml/dl, p = 0.02). Peak Fick cardiac output was decreased (39 +/- 3% pred) and CvO2 was elevated (130 +/- 10% pred), and neither improved with He-O2 (p > 0.05 for each). Abnormal peak exercise cardiac output and systemic O2 extraction in severe COPD cannot be fully accounted for by limiting pulmonary mechanics and may contribute to exercise intolerance.     

Survival and pulmonary hemodynamics in patients with sequelae of pulmonary tuberculosis who received antituberculosis chemotherapy and home oxygen therapy

To date, the pulmonary hemodynamics of patients with sequelae of pulmonary tuberculosis have usually been examined as a unified set of criteria regardless of the treatments that patients undergo. Attracted by this subject, we studied the cerrelations between survival and pulmonary hemodynamics in patients with sequelae of pulmonary tuberculosis who were treated with antituberculosis drugs and home oxygen therapy (HOT). Our study examined 21 patients with a mean ages of 58.0 years, mean PaO2 of 59.3 +/- 11.4 mm Hg, and mean PaCO2 of 51.9 +/- 6.3 mm Hg. In pulmonary function tests, mean % VC was 44.1 +/- 16.3%, and mean FEV 1%, 66.6 +/- 23.0%. Twenty of the patients were given a diagnosis of pulmonary hypertension. Eighteen of the patients received HOT; as a group, their 3-year survival rate was 62.6%, which was not statistically significant compared to survival observed in post Japanese studies. Among the HOT patients, blood gases and pulmonary hemodynamics did not vary significantly between those who died within 2 years after right heart catheterization (short-term survivors) and those who lived for more than 5 years (long-term survivors). However, VC, % VC, and FVC values were significantly lower in the short-term survivors than in the long-term survivors. In conclusion, these findings revealed no statistically significant, differences compared with the data from past studies. Although pulmonary hypertension is associated with the poor prognosis for chronic obstructive pulmonary tuberculosis patients, in the patients we studied, the principle prognostic determinant was the seriousness of the restrictive ventilatory impairment, not pulmonary hypertension.     

Long-term study of patients with pulmonary tuberculosis sequelae after bilateral thoracoplasty-airway obstruction and its causes

Chest roentgenograms and results of pulmonary-function tests in patients with pulmonary tuberculosis sequelae 30 years after bilateral thoracoplasty were studied retrospectively to detect airway obstruction in these patients and to determine its causes. For periods of more than 10 years, vital capacity (VC) changed at a rate of 15.5 +/- 5.0 ml/year, and forced expiratory volume in one second as a percent of VC (FEV1%) changed at a rate of 0.546% +/- 0.380% per year (n = 13). Thirty years after thoracoplasty, the VC was 920 +/- 180 ml (%VC = 28.4% +/- 5.3%), and the FEV1% was 66.2% +/- 13.7% (n = 21). Thus, mild airway obstruction was found in about half of the cases. For each patient, the distance from the hilum to the diaphragm was measured along the mid-clavicular line on the side with fewer ribs resected, and this distance was divided by the patient's height. The results of that computation was found to be significantly and negatively related to FEV1% (r = -0.681, which suggests that longer bronchi in the lower and middle lobes on that side were associated with lower values of FEV1%. These findings are similar to those in patients with pulmonary tuberculous sequelae after total pneumonectomy. Over an average of 26 years, scoliosis, the vertebra showing the most bending, the intrapulmonary lesion, and the position of the diaphragm did not change, but the cardio-thoracic ratio increased.     

Associations between breathing pattern during submaximal exercise and exercise capacity in patients with pulmonary emphysema

We sought to clarify the factors associated with exercise capacity in patients with pulmonary emphysema. Exercise capacities of 20 men with pulmonary emphysema were evaluated by bicycle ergometery, and the results were used to divide the subjects into two groups: high exercise capacity (n = 10) and low exercise capacity (n = 10). Pulmonary-function tests were done, emphysema scores were computed from CT scans, breathing pattern was recorded during submaximal exercise (up to 20 watts), and index of rapid shallow breathing was computed. Neither FEV1 nor airway resistance differed between the two groups, and patients with lower exercise capacity tended to have lower tidal volumes and higher values of the index of rapid shallow breathing during submaximal exercise. Functional residual capacity measured by body plethysmography and emphysema scores were inversely associated with exercise capacity. We speculate that among patients with pulmonary emphysema and a given degree of airway obstruction, a high functional residual capacity causes breathing during submaxinal exercise to be rapid and shallow, and that this rapid and shallow breathing makes ventilation inefficient, increases the work of breathing, and limits exercise capacity.     

Respiratory failure based on pulmonary tuberculosis sequelae and its management

According to the complexity of pathological change of pulmonary tuberculosis sequelae (TB seq), on which respiratory failure based shows the higher incidence of marked degree of hypoxemia and hypercapnia than that based on chronic pulmonary emphysema (CPE). In TB seq, pulmonary artery mean pressure is higher, nocturnal oxyhemoglobin desaturation is much lower than in CPE. Also hypoxemia on exercise is lower, and oxygen inhalation for this hypoxemia is more effective than in CPE. The most effective therapy is continuous oxygen therapy. Home oxygen therapy has improved the prognosis and quality of life (QOL) of patients with respiratory failure based on TB seq. Artificial positive pressure ventilation (TIPPV) with intubation or tracheotomy is carried out for patients with severe hypercapnia and respiratory acidosis. Recently, early application of nasal mask ventilation (NPPV) on patients with TB seq has prohibited acute exacerbation of chronic respiratory failure. And also for patients with severe hypercapnia, NPPV with BIPAP method is effective for their QOL. Comprehensive respiratory rehabilitation is also successfully applied for their management.     

Ventilatory support in the field

Ventilatory support during cardiopulmonary resuscitation can be accomplished with an array of methods and devices. These run the gamut from expired air resuscitation, including mouth-to-mouth and mouth-to-mask, to the use of ventilators including ventilator-to-mask and ventilator-to-artificial airway techniques. Appropriate application of these techniques depends on the clinical situation, rescuer training, and availability of equipment. This article discusses the proposed standards of emergency ventilatory support, the advantages and disadvantages of the techniques and devices used, and current controversies surrounding this topic.     

Adrenocortical function in patients with active pulmonary tuberculosis

STUDY OBJECTIVE: To assess adrenal function in patients with acute pleuropulmonary tuberculosis (APT) and compare it with that function in patients with community-acquired pneumonia (CAP). PATIENTS: Over a period of 6 months all consecutive patients 18 years of age or older with newly diagnosed APT and CAP were entered into the study. MEASUREMENTS: The whole patients had the following investigations: 1) Serum Na+, K+ and glucose concentrations 2) Systolic and diastolic blood pressures. 3) An ultrasonographic study of the adrenal glands. 4) A standard ACTH stimulation test. RESULTS: There was no significative difference in the serum cortisol level between the two groups at any time of the ACTH stimulation test (basal, 30 and 60 minutes), neither when taking into account the increments between basal and 60 minutes after stimulation serum cortisol levels. All patients in both groups had normal ACTH stimulation test with a peak stimulated cortisol level at 60 minutes > 504 nmol/L. CONCLUSIONS: We did not find evidence of adrenal cortical dysfunction in patients with acute pleuropulmonary tuberculosis or with community-acquired pneumonia in our hospital.     

Ventilatory response to positive and negative work in patients with chronic obstructive pulmonary disease

The consequences of extreme violence such as war torture affect children in different ways and may immediately manifest at the physical and/or psychologic level, or may remain hidden and unrecognized for years. The victims are usually very reluctant to speak about their traumatic experiences, and try to deny the existence of psychological disturbances. They often seek help for somatic problems. Taking these physical complaints seriously helps to progressively reach the psychological effects of violence. Therefore, identification of such children should be directed to more complete evaluation of their symptomatology and functioning. This can be done by: a) individual evaluation to get enough information on the historical events, functioning and symptoms of these children; and b) standardized instruments which may allow the children to disclose more about their psychological experiences during the war. In this study rating scales and assessment instruments for children aged < 15, such as CPRS with General Scoring Sheet (Fish, 1985), were used to assess the broad spectrum of psychopathology in this age group. These questionnaires were used in a large group of school children (N = 1888), 989 girls and 899 boys aged 7-16 years. The sample was divided into 3 groups: 843 non-displaced, 377 displaced and 669 refugee children. Results of statistical analysis (arithmetical mean and standard deviation of discriminative variables transformed in Z-values with F-ratio) showed the three groups of children (non-displaced, displaced and refugees) to significantly differ in 13 out of 15 psychopathologic clusters. Discriminative cannonic analysis of the 3 groups of children (non displaced, displaced and refugees) also showed significant differences. The first discriminative function (80.24% of total variance) indicated depression, violence and antisocial behavior to be rare in non-displaced children, more pronounced in displaced, and most pronounced in refugee children. The second discriminative function (19.76% of total variance) showed hyperactivity, anxiety and psychosomatic disturbances to be rare in non-displaced children; more frequent in refugee, and most expressed in displaced children. According to the results, the authors concluded that war is very painful for a large group of children, among whom the displaced and refugee children are most affected by psychopathologic disturbances.     

Problems in the treatment of patients with pulmonary tuberculosis

The paper presents the current approaches to chemotherapy in patients with pulmonary tuberculosis and shows the main reasons that do not allow one to achieve high outcomes of treatment. These involve the drug resistance of Mycobacterium tuberculosis, the morphological features of a specific process in the lung, the higher incidence of acutely progressive types of pulmonary tuberculosis in particular; tuberculosis-contaminant diseases (diabetes mellitus, gastrointestinal, hepatic, renal diseases, and non-specific respiratory diseases, etc.). Recommendations how to eliminate the reasons for ineffective treatment of pulmonary tuberculosis are given.     

Study of erythrocyte sedimentation rate in patients with pulmonary tuberculosis

We studied the erythrocyte sedimentation rate (ERS) and related factors that influence ESR in 326 patients with Pulmonary tuberculosis. The ESR tended to be higher for aged subjects and showed a difference between patients under 59 years old and patients over 60 years old. Besides, patients under 30 years old tended to present lower ESR. It is suggested that they may be under the influence of inapparent infection. For The Japanese Society for Tuberculosis Classification, a significant difference was noted in the extent, but there was no difference about the presence of cavity. A significant correlation was detected between ESE and Gaffky scale, ESR and CRP, and ESR and period until sputum culture became negative. But CRP negative cases were observed in about 28%. CRP alone was not sufficient for the evaluation of the morbid condition of Mycobacterium infection. Receiver-Operator Characteristic curve analysis confirmed that ESR is useful among patients with pulmonary tuberculosis. Therefore evaluation of ESR together with CRP was needed.     

Exacerbation of pulmonary tuberculosis during chemotherapy

Progression of a tuberculosis process during antituberculous therapy is most commonly evoked by its inadequacy. The latter may be associated with undiagnosed drug resistance, patients' incompliance due to the lack of their consciousness or discipline. In these circumstances, the use of stimulating pathogenetic treatments can provoke an exacerbation. Decreased immune defense mechanisms after experienced intercurrent infections may also serve as one of the common causes of tuberculosis exacerbations. Only in rare cases, progression of clinical and X-ray symptoms is explained by the massive pathogen lysis syndrome (Jarisch-Herxheimer's syndrome) The management policy for these patients should be different due to the causes of exacerbations.     

PCR-based rapid detection of Mycobacterium tuberculosis in blood from immunocompetent patients with pulmonary tuberculosis

A PCR test based on insertion sequence IS1081 was developed to detect Mycobacterium tuberculosis complex organisms in the peripheral blood. The method was applied to blood samples from immunocompetent individuals with localized pulmonary tuberculosis. Seven of 16 (43.75%) blood samples were found to be positive for the circulating DNA copies of M. tuberculosis complex.     

The prostacyclin-thromboxane system and bronchial patency in patients with pulmonary tuberculosis

The paper is concerned with a study in which a contribution was assessed of the prostacyclin-thromboxane system to the development of disturbances in bronchial patency in patients with pulmonary tuberculosis. It has been established that the prostacyclin-thromboxane system has an active part to play in the evolution and formation both the pattern of the tuberculous process and ventilatory disorders, the most important contribution being made by the proportion prostacyclin:thromboxane.     

Pneumotomy in treatment of patients with pulmonary tuberculosis complicated by aspergillosis

The ability of soil bacteria to produce amino acids (alanine, aspartic acid, leucine, arginine, glutamic acid, and lysine) was related to the ability to dissolve inorganic phosphate. With the exception of lysine, amino acid production increased with increasing ability to dissolve phosphate.     

Treatment of patients with chronic pulmonary tuberculosis with expectoration--evaluation of effectiveness

Two patients with multidrug-resistant pulmonary tuberculosis were surgically treated after 3 and 7 years of unsuccessful chemotherapy. There was pneumonectomy in one case and lobectomy with segmentectomy in the second. Pneumonectomy was complicated by bronchopleural fistula. Both patients become sputum culture negative after surgical treatment but first patient died 5 months after surgery because of acute hepatitis.     

HLA genes in patients with pulmonary tuberculosis in the Kirghiz population]

The immunogenetic features of the HLA system were studied in 116 Kirghiz patients with pulmonary tuberculosis and 120 apparently healthy individuals of the same nationality (a control group). HLA antigen typing was made by the routine microlymphocytotoxic test. The antigens Bw53, Bw62(15), DR2 and DR7 which should be regarded as markers of the disease were more commonly found in the HLA phenotype in Kirghiz patients with tuberculosis than in healthy individuals. The risk for tuberculosis increased in carriers having HLA haplotypes with the DR allele.