Bronchiectasis: the 'other' obstructive lung disease.

Bronchiectasis belongs to the family of chronic obstructive lung diseases, even though it is much less common than asthma, chronic bronchitis, or emphysema. Clinical features of these entities overlap significantly. The triad of chronic cough, sputum production, and hemoptysis always should bring bronchiectasis to mind as a possible cause. Chronic airway inflammation leads to bronchial dilation and destruction, resulting in recurrent sputum overproduction and pneumonitis. Once the diagnosis is confirmed, any potential predisposing conditions should be aggressively sought. The relapsing nature of bronchiectasis can be controlled with antibiotics, chest physiotherapy, inhaled bronchodilators, proper hydration, and good nutrition. In rare circumstances, surgical resection or bilateral lung transplantation may be the only option available for improving quality of life. Prognosis is generally good but varies with the underlying syndrome.

Alpha 1-antitrypsin deficiency and asthma. The continuing search for the relationship.

Patients with alpha 1-antitrypsin (AAT) deficiency, like those with asthma and chronic obstructive pulmonary disease, usually present with dyspnea, wheeze, and cough. The similarity in presentation and unfamiliarity among clinicians with AAT deficiency account for much of the delay in diagnosis. Normally, AAT inhibits serine proteases, which cause alveolar destruction, and alters the function of cells that release mediators of inflammation. Diagnostic findings suggesting deficiency include irreversible airflow obstruction, a decreased diffusing capacity of the lung for carbon monoxide, bibasilar bullous disease on chest films, and a low serum level of AAT. Asthma is usually diagnosed on the basis of clinical findings and response to inhaled beta agonists. The presence of inflammation is believed to be necessary for development of clinically significant asthma. Inflammation added to a deficiency of antiprotease inhibitor activity significantly worsens bronchial hyperreactivity. This is only one mechanism by which AAT deficiency may potentiate allergic and bronchospastic responses. The prevalence of bronchial asthma in patients with AAT deficiency is unknown. Studies by the National Institutes of Health regarding the natural history of AAT deficiency and its response to therapy are under way. Perhaps more will be discovered about the relationship between the disorder and bronchial asthma.

Inflammatory diseases of the lung causing false-positive 131iodine whole body scans in the evaluation of papillary thyroid carcinoma. Two case reports.

The 131I whole body scan is commonly used to establish the presence of metastatic disease in papillary thyroid carcinoma. False-positive scans are rare, but have been reported. We present two cases of aberrant uptake of radioiodine after thyroidectomy and 131I ablation due to inflammatory conditions of the lung, aspergilloma, and respiratory bronchiolitis.

Medical care of Iraqis at a forwardly deployed U.S. Army hospital during Operation Desert Storm.

To evaluate the injuries and diseases and their subsequent care for both Iraqis and U.S. soldiers in the Persian Gulf War, we analyzed all 196 admissions to the 46th Combat Support Hospital during Operation Desert Storm, with primary focus on the 118 admissions during the Ground War. Admission diagnosis was used to classify injury or disease. Percentage of patients who underwent surgery for combat wounds and percentage of patients who were air-evacuated were used as measurements of quality of care. The proportion of Iraqi patients who had been wounded in action was significantly higher than the proportion for Americans (95 vs. 53% for the Ground War). The rate of surgical procedures per wounded patients admitted was the same for Iraqis (28%) as for Americans (27%). Rates of air-evacuation for Iraqis were not statistically different from those for Americans in the same category of admission diagnoses. These last two findings suggest that the quality of care given to Iraqis was the same as that given to Americans.

The inpatient experience of a U.S. Army combat support hospital in the Persian Gulf during non-combat and combat periods.

To identify the key factors that control the workload of a U.S. military hospital during deployment, we studied all 574 admissions to the 46th Combat Support Hospital (CSH) during its deployment during Operations Desert Shield and Desert Storm. Date of admission, admission diagnosis, admitting service, length of hospitalization, disposition, nationality, and sex for each admission were analyzed. The workload of the 46th CSH varied markedly during the different periods of its deployment. Three hundred seventy-eight (66%) of the 574 admissions occurred during Operation Desert Shield, although admissions occurred at the greatest rate during the short Ground War phase of Operation Desert Storm. Iraqis accounted for 82% of the admissions during the Ground War and 51% of the total Desert Storm admissions. The most important factors determining the workload of the 46th CSH were the combat situation, effectiveness of the air-evacuation system, and the obligation to treat enemy soldiers and civilians.