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Relationship between bronchial anthracofibrosis and endobronchial tuberculosis.

Various pulmonary diseases may be associated with bronchial anthracofibrosis (BAF). Our aim was to identify a relationship between BAF and endobronchial tuberculosis (EBTB).
METHODS: In total, 156 patients, diagnosed with EBTB using bronchoscopy, between June 1999 and May 2008, were included. Clinical and bronchoscopic findings between patients with BAF (n = 72, BAF group) and without BAF (n = 84, non-BAF) were analyzed retrospectively.
RESULTS: The crude odds ratio (OR) of BAF for EBTB was 8.88 (95% confidence interval, 6.37 to 12.37). On multivariate analysis, adjusting for age, history of biomass smoke exposure, and comorbidities, the most significant independent factor for EBTB was a history of biomass smoke exposure (adjusted OR, 17.471; adjusted p < 0.001). EBTB was more frequent in the right lung, particularly the right middle lobar bronchus, in the BAF group. Actively caseating, edematous-hyperemic, and ulcerative were the major types, with 77 (49%), 33 (21%), and 31 cases (20%), respectively. The BAF group had more ulcerative type, while the non-BAF group had more actively caseating type. The duration of EBTB treatment was similar between the groups. No significant difference was observed in the development of complications during treatment and posttreatment bronchostenosis between the groups.

CONCLUSIONS: These findings suggest that BAF may be a risk factor for EBTB and affect the location and morphological type at the time of EBTB development.

Usefulness of cardiothoracic chest ultrasound in the management of acute respiratory failure in critical care practice.

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This study investigates the clinical relevance of early general chest ultrasonography (i.e. associating heart and lung ultrasound recording) in patients with acute respiratory failure (ARF) admitted to the intensive care unit (ICU).

METHODS: We prospectively compared this diagnostic approach ('Ultrasound') to a routine evaluation established from clinical, radiological and biological data ('Standard'). Patients were consecutively admitted to the ICU of a University Teaching Hospital during 1-yr period. Inclusion criteria were age at least 18 years and the presence of criteria of severe ARF justifying ICU admission. We compared the diagnostic approaches and the final diagnosis determined by the panel of experts.

RESULTS: Seventy-eight patients were included (age 70 +/- 18 yr; sex ratio 1). Three patients with two or more simultaneous diagnoses were subsequently excluded. The 'Ultrasound' approach was more accurate than the 'Standard' (83 % vs 63 % respectively, p &lt; 0.02). ROC curve analysis showed greater diagnosis performance of 'Ultrasound' in cases of pneumonia (standard: 0.74 +/- 0.12; ultrasound 0.87 +/- 0.14; p &lt; 0.02), acute hemodynamic pulmonary oedema (standard 0.79 +/- 0.11; ultrasound 0.93 +/- 0.08; p &lt; 0.007), decompensated chronic obstructive pulmonary disease (standard 0.8 +/- 0.09; ultrasound 0.92 +/- 0.15; p &lt; 0.05), and pulmonary embolism (standard 0.65 +/- 0.12; ultrasound 0.81 +/- 0.17; p &lt; 0.04). Furthermore, we showed that the use of ultrasound data, could have significantly improved the initial treatment.

CONCLUSIONS: The use of cardiothoracic ultrasound appears to be an attractive complementary diagnostic tool and seems able to contribute to an early therapeutic decision based on reproducible physiopathological data.

Surgery for secondary spontaneous pneumothorax: risk factors for recurrence and morbidity.

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Surgery for secondary spontaneous pneumothorax: risk factors for recurrence and morbidity.

Interact Cardiovasc Thorac Surg. 2013 May 14;

Authors: Isaka M, Asai K, Urabe N

Abstract
OBJECTIVESSecondary spontaneous pneumothorax (SSP) is more common in elderly patients; it has high rates of recurrence and mortality, even if surgery is performed. There has been little study on the surgical treatment of SSP. Therefore, we analysed the outcomes of surgical treatment of SSP patients, and investigated the risk factors of recurrence and morbidity.METHODSWe studied 97 consecutive surgical treatments on 94 patients with SSP who had emphysematous changes of lung retrospectively. Emphysematous changes on preoperative computed tomography image were evaluated by the Goddard score, which is a visual scoring system. First, video-assisted thoracoscopic surgery was performed, followed by bullectomy for the responsible lesions.RESULTSThe rate of morbidity was 20.6% and that of mortality was 4.1%. Recurrence rate was 9.3%. By multivariate analysis, a Goddard score ≥7 (odds ratio: 8.93, P = 0.033) and treatment of bulla without the use of staplers (odds ratio: 11.57, P = 0.019) were significant risk factors for morbidity, while pulmonary fibrosis tended to increase the risk of recurrence (hazard ratio: 4.21, P = 0.051), and a Goddard score ≥7 (hazard ratio: 7.79, P = 0.023) was a significant risk factor for recurrence.CONCLUSIONSSurgical treatment in patients with SSP had favourable results. Treatment in which the base of the bulla cannot be definitely shut off with staplers is associated with increased morbidity. Significant emphysematous change on preoperative computed tomography image and pulmonary fibrosis are predictors of recurrence. Patients with these findings should be investigated in terms of the indications of surgery and additional treatment, not only bullectomy.

PMID: 23674562 [PubMed - as supplied by publisher]

Inhaled Glycopyrronium Bromide: A Review of its Use in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease.

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Inhaled glycopyrronium bromide (Seebri(®) Breezhaler(®) capsules; NVA237) is a once-daily, long-acting muscarinic receptor antagonist (LAMA) that is approved in several countries, including the EU, as a maintenance bronchodilator for the symptomatic treatment of adult patients with chronic obstructive pulmonary disease (COPD).

In the randomized, controlled, phase III GLOW (GLycopyrronium bromide in chronic Obstructive pulmonary disease airWays clinical study)-1 and -2 trials, treatment with inhaled glycopyrronium bromide 50 μg once daily was associated with significantly better lung function than placebo in patients with moderate to severe COPD in terms of the trough forced expiratory volume in one second (FEV1) at 12 weeks (primary endpoint). Significant between-group differences in trough FEV1 in favour of inhaled glycopyrronium bromide were maintained for up to 52 weeks. Dyspnoea scores, health status and exacerbation rates were also improved to a greater extent in the inhaled glycopyrronium bromide than placebo groups in these trials. In the randomized, controlled, phase III GLOW3 trial, inhaled glycopyrronium bromide was associated with a significantly longer exercise endurance time than placebo after 3 weeks' treatment in patients with moderate to severe COPD.

The drug was generally well tolerated over the 26-week (GLOW1) or 52-week (GLOW2) study duration, and had a tolerability profile that was generally similar to that of tiotropium bromide. Serious adverse events were consistent with those expected in patients with moderate to severe COPD.

In conclusion, inhaled glycopyrronium bromide is a once-daily LAMA that is an effective bronchodilator for use in the treatment of patients with moderate to severe COPD.

PMID: 23677802 [PubMed - as supplied by publisher]

Increased prevalence of chronic obstructive pulmonary disease in a general population.

Prevalence of COPD is increasing worldwide, and there is need for regularly updated estimates of COPD prevalence and risk factors.

METHODS: In the Norwegian Hordaland County Cohort Study (HCCS), 1664 subjects aged 35-90 yrs answered questionnaires and performed spirometry in 2003-05. We estimated COPD prevalence and analysed risk factors for COPD with logistic regression.

RESULTS: In a previous study phase, prevalence of GOLD-defined COPD was 7%. Eight years later, corresponding prevalence was 14%. Seventy % of the subjects experienced respiratory symptoms. Only 1 out of 4 had a physician's diagnosis. Significant risk factors for COPD were sex, age, smoking habits and pack-years. Men had 1.7 (OR, 95% CI 1.2, 2.3) higher odds for COPD than women. Subjects above 65 yrs had 10.3 (OR, 95% CI 6.4, 16.5) times higher odds for COPD than subjects below 40 yrs. Heavy smokers had 4.2 (OR, 95% CI 2.6, 6.7) times higher odds for COPD than subjects with <10 pack-years. When compared with the previous study phase, age and smoking status had roughly the same associations with COPD prevalence. Educational level and male gender, on the other hand, had less effect on COPD prevalence in 2005 than in 1997, while pack years were more important in 2005 than in 1997.

CONCLUSIONS: Prevalence of GOLD defined COPD has increased from 7% to 14% in nine years. Although the risk factors remain the same, the strength of associations vary. There is still substantial under diagnosis in COPD, and better disease awareness and diagnostic routines are needed.

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