Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
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Monaldi Arch Chest Dis · Jun 1999
Randomized Controlled Trial Clinical TrialFour-week nebulized beclomethasone dipropionate in stable COPD patients with exertional dyspnoea.
Twenty male outpatients with severe-but-stable chronic obstructive pulmonary disease handicapped by exertional dyspnoea (aged 69.7 +/- 5.68 yrs; forced expiratory volume in one second (FEV1) 1.02 +/- 0.18 L or 34.6 +/- 6.5% of the predicted value; forced vital capacity (FVC) 2.51 +/- 0.34 L; arterial oxygen tension (Pa,O2) 9.11 +/- 0.32 kPa (68.5 +/- 2.4 mmHg); arterial carbon dioxide tension (Pa,CO2) 5.20 +/- 0.23 kPa (39.1 +/- 1.7 mmHg)) completed a randomized double-blind crossover study to evaluate the effects of a 4-week regular treatment with inhaled beclomethasone dipropionate via nebulizers at a dosage of 2 mg twice daily. After active and placebo treatment, no peak expiratory flow rate variation in FEV1, FVC, rescue use of beta 2-agonists, exercise tolerance and dyspnoea was observed. In conclusion, a regular short-term treatment with nebulized beclomethasone dipropionate does not give any improvement in lung function or exercise capacity in severe-but-stable chronic obstructive pulmonary disease patients handicapped by exertional dyspnoea.
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Intrapleural instillation of fibrinolytic agents has been shown, in a number of studies, to be an effective and safe mode of treatment in complicated parapneumonic effusions and empyema, minimizing the need for surgical intervention. Streptokinase and urokinase are the fibrinolytics used, but the technique of instillation is not yet standardized. The usual dose of streptokinase is 250,000 IU, 100,000 IU for urokinase. ⋯ Generally, fibrinolytics are more successful if used early in the process of pleural infection (in complicated parapneumonic effusions rather than in empyemas). Adverse reactions are rare, of the allergic type and more frequent for streptokinase. Urokinase is safer but more expensive.
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Monaldi Arch Chest Dis · Jun 1999
Case ReportsA case of bronchogenic carcinoma and concomitant Swyer-James syndrome.
A 46-yr-old male patient with the rare concomitance of Swyer-James syndrome in the left lung and small cell lung carcinoma in the right is presented in the light of pertinent literature.
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Monaldi Arch Chest Dis · Jun 1999
Combining transbronchial aspiration with endobronchial and transbronchial biopsy in sarcoidosis.
This study was carried out to evaluate the diagnostic yield and safety of flexible transbronchial needle aspiration (TBNA), endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB) combinations in stages I-III sarcoidosis (SA). Between 1989 and 1997, 74 patients suspected of having SA underwent fibreoptic bronchoscopy along with TBNA + EBB + TBLB or EBB + TBLB. During the same fibreoptic bronchoscopy, TBNA (using a 19-gauge histological needle and contrast-enhanced computed tomography (CT) guidance), EBB (from abnormal or normal bronchial mucosa) and TBLB were performed in stages I (n = 33) and II (n = 25), and EBB and TBLB in stage III (n = 16). ⋯ The combination of TBNA + EBB + TBLB and EBB + TBLB provided an overall sensitivity and accuracy of 90% and a specificity of 100%. All six (9%) significant complications--pneumothorax (four) and 40-100 mL haemorrhage (two)--were attributable to TBLB. It is, therefore, inferred that the combination of transbronchial needle aspiration, endobronchial biopsy and transbronchial lung biopsy in stages I and II, and that of endobronchial biopsy and transbronchial lung biopsy in stage III, is safe and cost-effective as well as increasing the diagnostic yield, and should therefore be performed routinely in the diagnosis of sarcoidosis.