British journal of diseases of the chest最新文献

A case of immotile-cilia syndrome associated with azoospermia is presented. This diagnosis is based on a typical history of bronchitis, sinusitis, situs inversus, impaired nasal mucociliary clearance and characteristic ultrastructural defect in the respiratory tract cilia and in the sperm tail. Semen analysis showed azoospermia with no evidence of obstruction in the epididymis or vas deferens; there was normal spermatogenesis.

Seventy-three patients with superficial lymph node tuberculosis, who received either 9 months' or 18 months' treatment with rifampicin and isoniazid, supplemented by ethambutol for the first 8 weeks, were followed up for 5 years. No clinical nor microbiological relapse was recorded. The cosmetic results were good in both groups. Initial surgery or aspiration conferred no advantage or disadvantage. The 9-month regimen can therefore be recommended as effective therapy for superficial lymph node tuberculosis.

Haemangiopericytoma, a rare mesenchymal tumour infrequently found within the thorax, is described in a patient who presented with a pleural mass following a lower respiratory tract infection. Specific radiological features leading to a diagnosis have previously been suggested; however, these are challenged in view of the findings in this case. Haemangiopericytoma ought to be considered in the differential diagnosis of an asymptomatic enlarging pleuropulmonary soft tissue mass.

We measured pulmonary epithelial premeability in 17 non-smoking patients with generalized bronchiectasis, of whom six had cystic fibrosis, by determining the half-time clearance from lung to blood ($\text{T}{}_{\mathrm{<mtext>1</mtext><mtext>2</mtext><mtext>LB</mtext>}}$) of inhaled ^99mTc-labelled diethylene triamine pentaacetate. Their age range was 15–79 years and the range of their FEV₁ measurements was 20–87% of the predicted normal Sputum obtained by prestudy chest physiotherapy revealed significant colonies of Psuedomonas aeruginosa in six, Haemophilus influenzae in three, Staphylococcus aureus in three and Pasteurella mitocida in one patient, while in the remainder there was normal floral only. Lung clearance was significantly faster in the 13 culture-positive patients (mean $\text{T}{}_{\mathrm{<mtext>1</mtext><mtext>2</mtext><mtext>LB</mtext>}}\text{=28}$ minutes) compared with the four culutre-negative patients (mean $\text{T}{}_{\mathrm{<mtext>1</mtext><mtext>2</mtext><mtext>LB</mtext>}}\text{=54}$ minutes). There was no correlation between $\text{T}{}_{\mathrm{<mtext>1</mtext><mtext>2</mtext><mtext>LB</mtext>}}$ and prestudy FEV₁. The study was repeated in six patients following a course of antibiotics. In two patients only was the sputum cleared of organisms and in those the lung permeability decreased significantly. There was no change in lung permeability in the four patients in whom it was impossible to eradicate the sputum organisms. Thus, in our patients with generalized bronchiectasis, lung permeability was increased only in those with both purulent sputum and significant colonization of the respiratory tract by bacterial pathogens. However, this increase in lung permeability was not associated with worse lung function.

Two cases of empyema with nephrotic syndrome are described, a previously unreported association. In one case the nephrotic syndrome resolved with treatment of the empyema. Renal biopsy in both patients showed mesangiocapillary glomerulonephritis and in one case there was evidence of activation of the alternative complement pathway, which is often associated with this histological type of glomerulonephritis.

The association between glomerulonephritis and empyema is important because it represents a potentially reversible form of renal disease.

We have conducted a survey of all asthmatic patients seen at the Leicester Royal Infirmary Accident and Emergency Department during a 1-year period. A significantly greater number of patients were seen on Sundays and bank holidays. Wheeze was recorded in only 43% of the patients and there was no record of any nocturnal asthmatic symptoms. Peak expiratory flow rate was only recorded in 26% of patients before treatment with nebulized salbutamol (the commonest treatment). Pulse rate, respiratory rate, time of day or month did not determine whether or not a patient was admitted. We conclude that the education of junior doctors in the management of asthma is still deficient.

Thirty-eight patients with carcinomatous pleural effusions had pleurocentesis performed with a fine bore silastic catheter sited under ultrasound guidance. Of these, 27 proceeded to pleurodesis. In the latter group there was a recurrence rate of 3.7% (one patient). Overall there was a complication rate of 26.3% (10 patients), only 5.2% (two patients) requiring active treatment. These results compare favourably with other methods of treatment.