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1.
Artículo en Inglés | IMSEAR | ID: sea-90019

RESUMEN

AIM: To evaluate the utility of bronchoalveolar lavage (BAL) in immunocompromised patients. MATERIAL AND METHODS: We studied BAL cytology and microbiological culture in 16 kidney transplant recipients (Group A), 14 dialysis patients (Group B) and eight HIV positive patients (Group C) suspected of having pulmonary infections. A group of 21 individuals without pulmonary diseases were studied as controls. RESULTS: A comparison of the cytological profile in controls and study groups showed that percentages of lymphocytes and neutrophils were significantly increased in all three patient groups as compared to controls, BAL bacterial cultures were positive in 4, 3 and 4 cases of Group A, B and C, respectively. Direct examination of BAL cytosmears helped in detecting cytomegalovirus inclusions, acid fast bacilli and Pneumocystis carinii in 3, 2 and 5 cases of Group A, B and C, respectively though microbial cultures were negative. The sensitivity of BAL cytology was found to be 76.3%, whereas that of microbial culture was only 31.5%. The diagnostic yield of BAL was 68.75%, 71.42% and 100% in the Groups A, B and C, respectively, while it was 76% when all three groups were considered together. BAL cytology yielded the diagnosis in 47.36% of cases, a combination of BAL cytology and culture in 23.68% and culture alone in 5.3% of cases. CONCLUSIONS: BAL is useful relatively non-invasive investigative tool in the rapid diagnosis of infections in immunocompromised patients. BAL cytology was found to be more useful than microbial cultures.


Asunto(s)
Lavado Broncoalveolar , Líquido del Lavado Bronquioalveolar/citología , Infecciones por VIH/inmunología , Humanos , Huésped Inmunocomprometido/inmunología , Insuficiencia Renal/inmunología , Trasplante de Riñón/inmunología , Diálisis Renal , Infecciones del Sistema Respiratorio/inmunología
4.
J Postgrad Med ; 1998 Jan-Mar; 44(1): 21-3
Artículo en Inglés | IMSEAR | ID: sea-117634

RESUMEN

The most hazardous manifestation of pulmonary alveolar proteinosis is progressive hypoxia for which bronchopulmonary lavage (BPL) is the single most effective treatment. Unfortunately this procedure under general anesthesia itself increases the risk of hypoxia due to the need for one lung ventilation. It was therefore considered interesting to report the successful anaesthetic management of a patient with pulmonary alveolar proteinosis for Bronchopulmonary lavage.


Asunto(s)
Adolescente , Anestesia General/métodos , Lavado Broncoalveolar/métodos , Humanos , Masculino , Proteinosis Alveolar Pulmonar/terapia
5.
Indian J Chest Dis Allied Sci ; 1996 Oct-Dec; 38(4): 227-33
Artículo en Inglés | IMSEAR | ID: sea-30185

RESUMEN

We report Pneumocystis carinii pneumonia (PCP) diagnosed by bronchoalveolar lavage cytology and transbronchial lung biopsy in three out of five human immunodeficiency virus (HIV) positive adult patients presenting with interstitial pneumonitis. One of these patients was serologically positive for HIV at the time of presentation and the remaining two patients were detected to be HIV positive on follow up after the diagnosis had been established. All the three patients were treated with co-trimoxazole. One patient recovered and was discharged; another patient improved with treatment but died after jugular vein cannulation and the third patient succumbed to cryptosporidial diarrhoea. The remaining two patients with non-specific interstitial pneumonitis treated with prednisolone and bronchodilators were recovered and were discharged from the hospital.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adulto , Líquido del Lavado Bronquioalveolar/citología , Femenino , Humanos , India/epidemiología , Pulmón/patología , Masculino , Persona de Mediana Edad , Neumonía por Pneumocystis/epidemiología
8.
J Postgrad Med ; 1993 Oct-Dec; 39(4): 190-3
Artículo en Inglés | IMSEAR | ID: sea-116287

RESUMEN

A prospective study of 76 consecutive patients over the age of 40 years, with exudative pleural effusion, was undertaken to determine the common causes of such a clinical condition. Malignant pleural effusions were the most common in this series, found in 49 patients (64.47%), all but one being metastatic from elsewhere. Forty were secondary to a carcinoma of the bronchus, 3 from carcinoma of the breast, 1 each from carcinoma of the ovary, oesophagus, and larynx; lymphoma accounted for the remaining 2. Infective causes accounted for 24 of the effusions (31.57%). Of the infections, tuberculosis was the most common, accounting for 17 of the 24. Other infective causes included bacterial empyemas in 4, ruptured amoebic liver abscess in 2, and actinomycosis in 1. Pancreatitis, pulmonary thromboembolism, and a post-cardiotomy syndrome were diagnosed in 1 patient each, while the diagnosis remained unknown in the remaining 5 patients. In 2 patients the diagnosis was made on autopsy.


Asunto(s)
Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Exudados y Transudados , Femenino , Humanos , Infecciones/complicaciones , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Derrame Pleural/química , Vigilancia de la Población , Estudios Prospectivos
10.
Artículo en Inglés | IMSEAR | ID: sea-85006

RESUMEN

With mucosal inflammation contributing to the pathogenesis of asthma, it is increasingly accepted that long term steroid inhalers may induce remission in chronic long standing asthmatics. The present study involved 44 stable asthmatics who were randomly given either beclomethasone dipropionate inhaler (50 ug) 2 puffs qds or salbutamol inhaler (100 mcg) 2 puffs tds in addition to their oral bronchodilators. Pulmonary function testing, bronchoalveolar lavage and complete blood count were done at basal and weekly intervals and at the end of the study. The absolute eosinophil count showed a significant drop in the beclomethasone group as compared to the salbutamol group. Serial lung functions showed a significant improvement in the pre-bronchodilator PEFR and the pre-bronchodilator FVC in the beclomethasone group as compared to the salbutamol group. There was no significant change in the lavage eosinophil count pre and post-bronchodilator in both groups. Steroid inhalers are thus useful in long term management of bronchial asthma especially with respect to reducing bronchodilator requirement.


Asunto(s)
Administración por Inhalación , Adulto , Albuterol/administración & dosificación , Asma/tratamiento farmacológico , Beclometasona/administración & dosificación , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad
12.
Artículo en Inglés | IMSEAR | ID: sea-87621

RESUMEN

Cardiopulmonary exercise testing has a definitive place in objective evaluation of the subjective sensation of breathlessness. In the present study 21 patients with COPD, 10 with ILD and 17 normals were subjected to stage 1 exercise testing and correlations were sought between Vo2 and work, FVC, FeV1, Ve, respiratory rate and tidal volume and between VCO2 and work. In COPD and ILD the Vo2 correlated with work, Fev1, Fvc and Ve whereas in normals it correlated with the VE but not with the FeV1 and FVC. In COPD VO2 correlated with TV though this was not the case in ILD. Thus stage 1 exercise testing can be a useful additional method to assess the disability in COPD and ILD although differentiation between these two respiratory diseases on basis of exercise testing alone may not be possible.


Asunto(s)
Adulto , Bronquitis/diagnóstico , Disnea/diagnóstico , Prueba de Esfuerzo , Femenino , Humanos , Pulmón/fisiopatología , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Obstructivas/diagnóstico , Mediciones del Volumen Pulmonar , Masculino , Oxígeno/fisiología
15.
J Postgrad Med ; 1992 Jul-Sep; 38(3): 124-6
Artículo en Inglés | IMSEAR | ID: sea-116642

RESUMEN

The effect of inhalation of ipratropium bromide was evaluated in 20 patients with bronchial asthma. It was observed that there was no significant improvement in the forced vital capacity and the forced expired volume in one second, while there was significant improvement in the peak expiratory flow rate (PEFR) measured at 9 pm, after inhalation of 2 puffs of ipratropium bromide aerosol (0.02mg/puff) three to four times a day for 2 weeks. Since PEFR is a measure of large airway function and cholinergic mechanisms are primarily involved for airflow obstruction at large airways, improvement in PEFR by ipratropium bromide highlights its role as a useful bronchodilator in patients in whom vagal reflexes are responsible for the provocation of bronchoconstriction.


Asunto(s)
Administración por Inhalación , Adolescente , Adulto , Aerosoles , Asma/tratamiento farmacológico , Esquema de Medicación , Femenino , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Ipratropio/administración & dosificación , Masculino , Ápice del Flujo Espiratorio/efectos de los fármacos , Factores de Tiempo , Capacidad Vital/efectos de los fármacos
18.
Artículo en Inglés | IMSEAR | ID: sea-89468

RESUMEN

One hundred and thirty-seven patients of advanced pulmonary tuberculosis were randomly allocated to receive metronidazole 400mg tid (76) or placebo (61) for 2 months in a single blind study. All received streptomycin 0.75 g,INH 30 mg and rifampicin 450 mg daily as standard antitubercle treatment. There were no significant pretreatment differences, among both groups. Compared to placebo group there was superior clinical improvement in metronidazole treated group at 4 and 8 weeks (81% vs 53%-P less than 0.05; 87% vs 72%-P less than 0.05 respectively), greater sputum reduction at 4 weeks (49% vs 9%-P less than 0.001) greater radiologic improvement at 4 weeks (60% vs 43%-P less than 0.01) and a better antituberculous drug sensitivity. Metronidazole seems to have beneficial adjuvant role in the drug treatment of tuberculosis. This may improve response in advanced cases.


Asunto(s)
Adolescente , Adulto , Antituberculosos/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Tuberculosis Pulmonar/tratamiento farmacológico
19.
J Postgrad Med ; 1989 Jul; 35(3): 123-34
Artículo en Inglés | IMSEAR | ID: sea-117637

RESUMEN

The experience of the intensive respiratory care in 930 cases treated from 1983 for 4 years and in 404 cases over the next 2 years is reported. The background operational problems are stressed. Those between age 10 and 50 years did significantly better (p less than 0.05). The survival over the first 4 years in IPPR cases was 16.3% and in non IPPR group 71.8%; over the next 2 years, the former group, survival was 32.4 and 36.3%. The survival in asthmatic patients was high (76%). In cases with organophosphorus poisoning (without IPPR), survival was 81% while in IPPR group it was 29%. In 1988, the results in this group were better due to more aggressive management. In autopsy data on 85 cases, infection was not a major feature in those dying within 24 hours. The survival in COPD cases showed significant relation to age (p less than 0.05), initial arterial pO2 below 60 mm (p less than 0.01) and arterial pH below 7.3 (p less than 0.01). In cases with pneumonia (also asthma) younger cases did better (p less than 0.05) as also those with pneumonia and initial pO2 above 60 mm (p less than 0.01) and pH above 7.3 (p less than 0.001). When pneumonia was community acquired, survival (64.8%) was better than when it was hospital acquired (24%; p less than 0.01). Only the need for IPPR affected survival in trauma group. The major cause of death was infection with Klebsiella, Pseudomonas, Staphylococci and other gram--ve organisms. It is concluded that with proper planning and training, the IRCU does provide a useful mode of treatment in selected patients with respiratory problems.


Asunto(s)
Adolescente , Adulto , Niño , Femenino , Humanos , India/epidemiología , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae/aislamiento & purificación , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Infecciones por Pseudomonas/epidemiología , Unidades de Cuidados Respiratorios , Insuficiencia Respiratoria/microbiología , Infecciones Estafilocócicas/epidemiología
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