Respiration; international review of thoracic diseases
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Asthma and chronic obstructive pulmonary disease (COPD) are complex conditions with imprecise definitions which make definitive morphological comparisons difficult. Broadly, the airways in asthma are occluded by tenacious plugs of exudate and mucus, there is fragility of airway surface epithelium, thickening of the reticular layer beneath the epithelial basal lamina and bronchial vessel congestion and oedema. There is increased inflammatory infiltrate comprising 'activated' lymphocytes and eosinophils with release of granular content in the latter, and there is enlargement of bronchial smooth muscle particularly in medium sized bronchi. ⋯ In small (peripheral) airways disease, there is inflammation of bronchioli, mucous metaplasia and hyperplasia, with increased intralumenal mucus, increased wall muscle, fibrosis and airway stenoses. Respiratory bronchiolitis is a critically important early lesion which may predispose to the development of centrilobular emphysema. The severity of destruction of alveolar wall in emphysema appears to be the most important determinant of chronic deterioration of airflow.
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Comparative Study
Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax.
In this prospective study, the value of computed tomography (CT) in detecting bullae and bleb formation of the lung in 35 patients with primary spontaneous pneumothorax (PSP) has been determined. The ability of CT in the detection of bullae and bleb formation and fibrotic changes is compared with the chest film in PSP. CT showed pathological lung changes in 31/35 patients. ⋯ Additionally, 2 recurrences occurred. No correlation between recurrences and anatomical status (number, size and distribution of blebs/bullae) as assessed by CT was found. Differential treatment protocols on the basis of the initial findings do not appear to be warranted.
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The Medical Research Council and the Nocturnal Oxygen Therapy Trial studies clearly demonstrated that long-term oxygen therapy (LTOT) for more than 15 h/day improved mortality and morbidity in a well-defined group of patients with chronic obstructive pulmonary disease. There are no similar randomised control studies in patients with other hypoxaemic lung diseases such as pulmonary fibrosis and pneumoconiosis. The prescription of oxygen for other restrictive lung disorders is complicated by hypoventilation requiring mechanical support as well as oxygen and should be restricted to special centres. ⋯ FEV1 should be less than 1.5 litres, and there should be a less than 15% improvement in FEV1 after bronchodilators. All patients should be assessed by an experienced chest physician. Patients with a PaO2 between 7.3 and 8 kPa who have polycythaemia, right heart failure or pulmonary hypertension may gain benefit from LTOT but this is still to be clearly proven.(ABSTRACT TRUNCATED AT 250 WORDS)
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We report a case of pulmonary tuberculosis with bilateral hilar lymphadenopathy. Open thoracic lymph nodes and lung biopsy revealed findings consistent with sarcoidosis. ⋯ Culture of the postoperative sputum grew Mycobacterium tuberculosis and antituberculous therapy resulted in a decrease in sizes of the lymphadenopathy. A review of the literature, with emphasis on the differential diagnosis between tuberculosis and sarcoidosis, is discussed.
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Mucoid impaction of tracheobronchial tree is a common condition which may complicate tracheostomy. Here we describe a case of a 72-year-old man, status after tracheostomy, who presented to the hospital with an acute upper airways obstruction and respiratory arrest due to a tracheal cast. The cast was successfully dislodged by the Nd-Yag laser.