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Query: UMLS:C0729233 (Thoracic)
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The prevalence of respiratory problems and the ventilatory functions in subjects belonging to three sample areas with different levels of pollution was studied to ascertain if there is any association between air pollutant levels and abnormal ventilatory functions. The predominant activity existing in that area served as the basis for stratification of the city into industrial (Group I), commercial (Group II) and residential (Group III) areas. Ambient air quality data of suspended particulate matter SPM, SO2 and NOx of the three sample areas were measured using standard methods. 216 men included in the study were administered the American Thoracic Society--Division of Lung Diseases ATS-DLD respiratory questionnaire, clinically examined and subjected to routine laboratory investigations. Spirometry and salbutamol reversibility tests were performed as per the ATS guidelines 1991. The mean and peak levels of SPM in the commercial area and the peak levels in the residential area were higher than the National Ambient Air Quality Standards (NAAQS). The mean and peak levels of NOx and SO2 in all the three areas were lower than the NAAQS. A high prevalence of approximately 30-50% of respiratory symptoms was reported in the present study. Respiratory and ventilatory abnormalities were higher in the commercial areas, which are associated with the higher mean and peak levels of SO2 and the peak levels of NOx. The pollution control measures should also aim at the peak levels of pollutants as they have been shown to exacerbate the respiratory symptoms in the present study.
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PMID:Respiratory symptoms and spirometric observations in relation to atmospheric pollutants in a sample of urban population. 1183 20

This study aimed to describe and correlate the chest radiography and CT findings of Mycobacterium avium complex (MAC) lung disease in immunocompetent patients. 26 patients fulfilled The American Thoracic Society criteria for MAC lung disease and underwent chest radiography and CT within 6 weeks of positive cultures. All abnormalities and predominant lobar involvement were recorded and abnormalities on chest radiography were correlated with those on CT. The images were evaluated by two chest radiologists and decisions were reached by consensus. 21 females and 5 males, with an overall mean age of 69 years, were included in the study. All chest radiographs and CT scans were abnormal. On chest radiography, overinflation was demonstrated in 18 patients. CT scan abnormalities included atelectasis (n=17), bronchiectasis (n=24), cavities (n=13), consolidation (n=3), emphysema (n=11), ground-glass opacity (n=8), linear opacities (n=26), mediastinal lymphadenopathy (n=3), nodules (n=25) and pleural disease (n=15). CT findings were at variance with chest radiography findings in 15 lobes. A new feature from this study is that the majority of patients with MAC lung disease demonstrate overinflation on chest radiography. 19% of cases had predominant upper lobe disease, indistinguishable from post-primary Mycobacterium tuberculosis infection. 77% of cases demonstrated the major imaging criteria of MAC lung disease. These are ill defined nodules, bronchiectasis, predominant middle lobe and/or lingular abnormalities, with or without overinflation. We believe that these characteristic radiological signs will assist the physician in the diagnostic work-up of patients with MAC lung disease.
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PMID:Mycobacterium avium complex lung disease in immunocompetent patients: radiography-CT correlation. 1200 Jun 92

Although the US Centers for Disease Control (CDC) should report that the total number of tuberculosis (TB) cases has dropped 5.1% since 1992, experts stress that the potentially fatal lung disease is not yet under control. The incidence of drug-resistant TB remained about 13.7% of all reported TB cases in 1991 and 1992. TB is most commonly treated through the administration of four drugs given three times per week over a six-month period. TB experts and treatment specialists at the CDC and the American Thoracic Society jointly issued new treatment guidelines stressing the importance of ensuring that patients take all of their prescribed medications, even if it means going into the community and watching them swallow their pills. Patients who fail to adhere strictly to their treatment regimen of drugs risk developing drug-resistant TB disease and present a contagious public health threat. In addition to the acute risk of mortality from such resistant disease, the treatment cost of up to $150,000 dwarfs the $1,500-3,000 total expense required to treat patients with non-resistant TB under the new community based treatment program, Directly Observed Therapy (DOT). In DOT, health workers visit patients with TB in the workplace, home, and community to monitor their timely ingestion of prescribed medication against TB. Some patients have reported preference for this approach since it removes any personal worry that they may forget to comply with treatment on a regular basis. The experts also recommend that HIV-seropositive people with TB receive standard TB therapy and suggest treating TB positive parents with preventive drug therapy to control TB in children even if the children test negative for TB. The World Health Organization predicts that more than one third of the eight million new cases of TB this year will occur in people with AIDS.
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PMID:To conquer TB, patients must take their medicine. 1217 76

The prevalence of nontuberculous mycobacteria (NTM) is high (approximately 13%) in sputum of patients with cystic fibrosis (CF), but the impact on lung disease is unknown. We followed 60 incident NTM-positive and 99 culture-negative patients with CF for 15 months and assessed clinical impact of NTM by FEV1 and high-resolution computed tomography (HRCT) of the chest. Mycobacterium avium complex was seen in 75% of NTM-positive subjects. The annual rate of decline in FEV1 was not different among control versus NTM-positive subjects who did not, or did, meet American Thoracic Society microbiologic criteria for NTM disease (3 +/- 1, 3 +/- 2, and 5 +/- 2%, respectively). More subjects with three or more positive cultures for NTM had two or more characteristic findings on entry HRCT (60%, 9/15) as compared with subjects with two positive cultures or less (32%) or negative cultures (19%; p < 0.02). All subjects with three or more positive cultures and exit HRCTs (n = 6) showed progression of HRCT findings, whereas only 17% of subjects with two positive cultures or less had progression (p = 0.0006). In summary, no significant short-term effect on FEV1 was detected in patients with multiple positive NTM cultures, but an abnormal HRCT was predictive of progression. Patients with CF and multiple positive NTM cultures, characteristic HRCT findings, and progression of HRCT changes should be monitored closely and considered for antimycobacterial therapy.
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PMID:Nontuberculous mycobacteria. II: nested-cohort study of impact on cystic fibrosis lung disease. 1262 56

A number of studies have documented subjective improvement in somatic and psychological symptoms following breast reduction surgery. Objective data demonstrating improved postoperative function have been more difficult to assess, and particularly with respect to pulmonary function, the results have been contradictory. In this prospective study, patients completed a comprehensive preoperative questionnaire modified from the American Thoracic Society Division of Lung Diseases Epidemiology Standardization Project (1978). This questionnaire noted subjective pulmonary symptoms and pulmonary medical history. In addition, subjective symptoms related to breast size, including back and neck pain and shoulder pain and grooving, and a subjective evaluation of body image, were evaluated. All subjects received preoperative pulmonary function testing, including spirometry, lung volume measurements, and measurement of peak inspiratory and expiratory flow rates and pressures. Eight weeks after breast reduction, a repeat questionnaire and pulmonary function testing were administered. Preoperative and postoperative pulmonary function values were compared using Cochran-Mantel-Haenszel tests, and correlations were tested between changes in pulmonary function test values and subjective symptom improvement. Forty-four patients underwent an average of 2228-g bilateral reduction. All of these patients had their surgical procedures preauthorized as medically necessary by their insurance carriers. All subjective parameters examined were statistically significantly improved following breast reduction (p < 0.001). Of the 17 patients with preoperative complaints of shortness of breath, all noted significant improvement following breast reduction surgery (p < 0.001). Of the objective pulmonary criteria evaluated, inspiratory capacity, peak expiratory flow rate, and maximal voluntary ventilation showed a statistically significant improvement following surgery (p < 0.05). These changes correlated with body mass index; the greater the index, the greater the change in maximal voluntary ventilation and peak expiratory flow rate. Smokers in this group had the largest change in maximal voluntary ventilation (p < 0.008). No correlation could be found between preoperative pulmonary symptoms, a single subjective symptom, or grams of breast weight reduction and changes in pulmonary function tests. The results show that pulmonary parameters, related primarily to work of breathing (inspiratory capacity, maximal voluntary ventilation, peak expiratory flow rate), were statistically improved following breast reduction surgery, and these changes correlated with body mass index.
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PMID:Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. 1466 67

A recent document of the American Thoracic Society and two previous reports of the International Union Against Tuberculosis and Lung Disease have summarized the negative health effects due to air pollution in a list ranging from the increase of mortality to the perception of bad odors. A significant attempt to estimate, on an annual basis, the negative effects of air pollution from particulate matter less than 10 microns in aerodynamic diameter (PM10) has been carried out on data from Austria, France, and Switzerland: e.g. in France, air pollution from PM10 is responsible annually for 31,700 deaths, 36,700 new cases of chronic bronchitis and 577,000 attacks of asthma in adults, 450,000 cases of acute bronchitis and 243,000 attacks of asthma in children. Recently, a study on the long-term effects of air pollution on about 500,000 residents in metropolitan US areas evidenced that each 10 micrograms/m3 elevation in fine particulate air pollution is associated with approximately a 4%, 6% and 8% increased risk of all-cause, cardiopulmonary and lung cancer mortality, respectively. Some Italian experiences have also confirmed respiratory health damages from air pollution, namely the prospective epidemiologic studies on general population samples of the Po Delta and Pisa areas; the cross-sectional study on schoolchildren of the 'Italian study on respiratory disorders in childhood and environment' (SIDRIA); and a meta-analysis of the Italian studies on short-term effects of air pollution. In conclusion, epidemiologic studies suggest that air pollution plays an important role in the exacerbation and in the pathogenesis of chronic respiratory diseases. Thus, respiratory physicians, as well as public health professionals, should advocate for a cleaner environment.
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PMID:Respiratory effects of environmental pollution: epidemiological data. 1261 72

1. Thoracic insufficiency syndrome is the inability of the thorax to support normal respiration or lung growth. 2. The rare condition of fused ribs and congenital scoliosis may result in a three-dimensional thoracic deformity with adverse effects on thoracic growth and function with development of thoracic insufficiency syndrome. 3. The normal thorax is defined by two characteristics: normal, stable volume and the ability to change that volume. Volume depends on the width and depth of the rib cage, and the thoracic spine provides height. The ability to change volume, termed thoracic function, is provided by the diaphragm and the secondary muscles of respiration. 4. On radiographs, the loss of the vertical height of the lung of the concave, restricted hemithorax is defined by the percentage of space available for the lung. 5. Spine rotation causes a windswept thorax, with both restriction of the volume of the convex hemithorax and restriction of the motion of the involved ribs. 6. Constrictive three-dimensional deformity of the thorax may cause extrinsic, restrictive lung disease. 7. Progressive thoracic insufficiency syndrome is diagnosed on the basis of clinical signs of respiratory insufficiency, loss of chest wall mobility as demonstrated by the thumb excursion test, worsening indices of three-dimensional thoracic deformity on radiographs and computed tomography scans, or a relative decline in percent predicted vital capacity due to thoracic "failure to thrive," as demonstrated by pulmonary function tests. 8. Treatment of progressive thoracic insufficiency syndrome should provide an acute increase in the thoracic volume with stabilization of any flail chest-wall defects and maintain these improvements as the patient grows, without the need for spine fusion.
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PMID:The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. 1263 23

The literature concerning the management of pulmonary disease caused by Mycobacterium malmoense consists of retrospective reports on small series of patients. A recent multicentre trial conducted by the British Thoracic Society provided an opportunity to prospectively document the clinical features and response to treatment of this relatively rare but challenging disease in a substantial number of patients. When two positive cultures were confirmed by the Mycobacterium Reference Units for England, Wales, Scotland or Scandinavia, the coordinating physician invited the patient's physician to enrol the patient, who was then treated on a random basis with either rifampicin plus ethambutol or rifampicin, ethambutol and isoniazid for 2 yrs. Clinical, bacteriological and radiological progress were monitored at set intervals for 5 yrs. In over 5 yrs a total of 106 patients were recruited to the study. The mean age was 58 yrs, range 24-89 A total of 58% were male and just over half previously or at the time ofthe study had other lung diseases. Sputum was positive on direct smear in 58%. Cavitation was seen on the chest radiographs of 74%, the majority having cavities of > or = 2 cm in diameter. Less than half of the patients showed bilateral disease, 26% having involvement of more than three lung zones. Disease was confined to the upper zone(s) in 30%. Other lung diseases were evident in 52%. Although clinical response was judged satisfactory at most reviews (90%), one in three patients died within 5 yrs and <5% were thought to have died primarily because of M. malmoense. There were three failures of treatment and eight relapses after the end of treatment. There was no correlation between failure of treatment/relapse and in vitro resistance. A total of 63 (59%) of patients were alive at 5 yrs, of whom 44 (42% of the total entry) were known to be cured. Pulmonary disease caused by Mycobacterium malmoense is a serious condition that is associated with high morbidity and mortality. The results of standard susceptibility tests do not correlate with the bacteriological response of the disease to chemotherapy. Rifampicin and ethambutol, with or without isoniazid, cured only 42% of patients but were better tolerated than previously described, more complex regimens of equal or lesser efficacy. There is a need for more effective regimens that will reduce mortality and failure of treatment/relapse rates, but, in addition, attention should be directed at improving management of comorbid conditions and improving the general health of the patient.
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PMID:Pulmonary disease caused by M. malmoense in HIV negative patients: 5-yr follow-up of patients receiving standardised treatment. 1266 5

The cardiovascular effects observed with epidural anaesthesia are complex and are predominantly related to the extent of sympathetic denervation, autonomous balance, baseline blood volume and cardiovascular function of the patient. With epidural anaesthesia the pharmacological effect of systemically absorbed local anaesthetic agents and inclusion of adrenaline to the local anaesthetic solution may play a role. Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone prior to the block. Epidural anaesthesia per se has little effect on respiration in patients with pre-existing lung disease. Thoracic epidural anaesthesia appears to reverse the diaphragmatic dysfunction which is a major determinant of the decrease in lung volumes observed after upper abdominal surgery. This article summarizes cardiovascular and pulmonary responses to epidural anaesthesia.
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PMID:Cardiovascular and pulmonary effects of epidural anaesthesia. 1276 79

Spontaneous pneumothorax is a frequent affliction. The primary type principally affects males in the third decade of life, while the secondary type affects elderly patients with lung disease. When reviewing the cases of pneumothorax registered by the Thoracic Surgery Unit of the Hospital of Navarra, we found an incidence similar to other countries in our geographic area, and a biphasic distribution of the disease with the incidence peaks in youth and old age that we have mentioned. The disease is more frequent in males, smokers, and during the winter months. An account is given of the physiological mechanisms responsible for the formation of bullas in puberty. The first step in treatment is pleural drainage, the aim of which is to achieve pulmonary re-expansion and the re-establishment of the integrity of the visceral pleura. Although there are controversies regarding the definitive treatment, we carry out surgical resection of the pulmonary bullas in cases of relapse or when the CAT indicates a high risk of relapse, or resection of the pulmonary vertex following a second episode in spite of the non-existence of lesions in the CAT. We do not carry out pleurodesis, except in elderly patients who are not susceptible to surgery. Our results are similar to those obtained by other groups with respect to relapses, low morbidity and nil mortality in primary spontaneous pneumothorax.
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PMID:[Spontaneous pneumothorax: review of 130 cases]. 1287 78


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