Search

To determine the diagnostic value of ultrasonic lung aspiration for patients with pneumonia, 60 patients with a tentative diagnosis of pneumonia were included in this study. After recording ultrasonographic findings, lung aspiration was done with a spinal needle and aspirated specimens were sent for Papanicolaou, May-Giemsa, acid fast, and Gram stains. The remaining specimens were sent for bacterial, mycobacterial and fungal culture. Twelve patients were excluded from the study because of the final diagnosis of non-infectious pulmonary diseases. In 28 cases of bacterial pneumonia, the diagnostic sensitivity of smear was 50% and culture 61%. The overall sensitivity of needle aspiration and culture was 71%. In 11 cases of bacterial pneumonia with a negative bacterial culture result, 7 cases were afebrile at the time of examination. To increase the diagnostic yield, needle aspiration should be performed at the acute stage of bacterial pneumonia. In 15 cases of pulmonary tuberculosis, the diagnostic rate of acid-fast smear was 47% and mycobacterial culture was 46%. The overall sensitivity of smear and culture was 60%. The diagnostic rate of needle biopsy was 75% and cytologic examination was 77%. Needle biopsy and cytologic examination enhanced the diagnostic rate of sputum-negative pulmonary tuberculosis. Cryptococcosis was documented by smear and needle biopsy in all of the five cases of cryptococcosis. Cryptococcosis is not easily detected by routine cytologic examination, and clinical information is still necessary to enhance the diagnostic rate. Our results show that ultrasonically guided lung aspiration is a technique with a high diagnostic yield and a low complication rate for various types of pneumonia. It is especially useful for patients without satisfactory clinical responses or without accurate microbiologic diagnosis.

Many reports have shown that rifampicin could induce a variety of adverse effects. However, anaphylactic shock occurring after readministration of rifampicin, to our knowledge, has not been reported thoughtfully. Herein we present a case with anaphylactic shock after readministration of rifampicin. The possible mechanism may be the interaction between IgE antibody and mast cell or basophils. Compared with continuous regimen, intermittent rifampicin regimen has longer interval to accumulate more rifampicin-induced antibodies, and more immunogenic side effects are the sequelae when re-encountered with rifampicin.

Eleven cases of diffuse panbronchiolitis (DPB) were reported. According to plain chest film (10 cases) and high-resolution computed tomography (HRCT) (11 cases) findings, all were grouped as x-ray type B or CT type II advanced stage. Among them, 4 cases were grouped between CT type II-III; 3, CT type III-IV. All 11 patients had history of chronic paranasal sinusitis (CPS). Three patients had HLA typing. 1 had positive HLA Bw54; 3, HLA Cw1. We suggested patient with CPS, positive HLA Bw54 and Cw1 typing and clinically suspected DPB, radiological study including HRCT should be done.

We diagnosed 627 cases of SCLC from 1971 to 1985 in VGH-Taipei. Sixty-nine cases received no treatment, while 558 cases received treatment including chemotherapy, radiotherapy, surgical intervention or combined modality. The median survival time of the treated group and untreated group was 6 and 1 months respectively (p less than 0.001). Female sex was a positive prognostic factor (p less than 0.05) and median survival time of female and male were 7 and 5 months respectively. Age (older or younger than 65 y/o) was not a significant prognostic factor in our series (p = 0.13). Thirteen cases (2.33%) of patients in the treated group survived longer than 5 years. Among them, 11 cases were limited disease and 2 cases were extensive disease. The characteristics of these 13 patients were analysed to find them in relatively good performance status, less body weight loss, less biochemical abnormality and more limited disease. In them, no secondary tumor was noted during the follow-up period.

A case of neurogenic pulmonary edema following a grand mal epileptic seizure is presented. This condition is rather rare and the exact pathophysiology remains unknown, but it is believed that the event may be related to transitional increase of intracranial pressure during seizure attack. Pulmonary edema may be a serious complication of epileptic seizure. Rapid recognition and management is very important since the prognosis depends on the severity of pulmonary edema and appropriate treatment.

In order to evaluate whether age and pulmonary function testing may predict postoperative morbidity and mortality in the patients having received thoracic surgery, 203 patients were included in this study. Spirometry, flow volume curve, lung volume determination and arterial blood gas analysis were performed in all of them. Postoperative complications were classified into respiratory complications including pneumonia, purulent bronchitis, atelectasis, respiratory failure and so on; and non-respiratory complications including subcutaneous emphysema, internal bleeding, stump leakage, dysarrythmia and so on. Of the 117 patients over 65 years of age, 27 (23.1%) had postoperative respiratory complications, 27 (23.1%) had non-respiratory complications, and 7 (5.93%) expired postoperatively. Of the 86 patients under 65 years of age, 21 (24.4%) had postoperative respiratory complications and 9 (7.6%) had postoperative non-respiratory complications, but one expired. The incidences of postoperative mortality and non-respiratory complications were both higher in the patients over 65 years of age (p less than 0.05). Our results indicated that age is a risk factor of thoracic surgery, even if the pulmonary function testing meet the surgical criteria.

Nocardiosis is an illness caused by members of the genus Nocardia. Although it is usually an opportunistic infection in immunocompromised hosts, it can also occur in patients without a definable predisposing condition. Three species are recognized as being responsible for what most frequently seen. The primary site of infection is overwhelmingly the lungs. Brain abscess is by far the most common site for nocardial metastasis from pulmonary lesion. Although surgical intervention must always be considered in the treatment of nocardial brain abscess, it can clearly be cured by medical therapy alone. We report this case and also review the literature.

Bronchopulmonary sequestration is a rare congenital anomaly in which part of the pulmonary tissue is detached from the normal lung without normal connection with tracheobronchial trees and pulmonary artery. It is supplied by anomalous systemic artery. Pseudosequestration is referred as the combination of systemic arterial supply to lung with normal bronchial connection and coexistent infection. It is presumed that chronically inflamed lung may activate neovascularization from systemic circulation in this strage, we reported 15 cases of all pulmonary sequestration and 1 case of pseudosequestration. Most of the cases were young adults with the mean age of 24.6 years old. The intralobar type comprised 86.6% of all cases. In 84.6% of the cases, the aberrant artery originated from the thoracic aorta. Preoperative diagnosis was gained in 47% of cases. In 80% of all cases, the chest mainly characterized with homogeneous mass lesion or cyst(s) with air-fluid level. The distinction between sequestration and pseudosequestration is a diagnostic challenge because the radiologic findings are similar between both conditions. There are clinically significant complications, such as recurrent infections or massive bleeding during operation.

Mycobacterial lymphadenitis is still a common and often poorly treated disease. Cervical lymph-node is most frequently involved. Mycobacterium tuberculosis clearly preponderates as the cause of mycobacterial cervical lymphadenitis in adults while other mycobacteria (MOTT) area mostly the causes of the same disease in children. Diagnostic methods and treatment choices between both groups are therefore different. It seems appropriate to perform total excisional biopsy in children especially in R.O.C. where skin test to differentiate between TB and MOTT is useless due to BCG vaccination. Current policy for mycobacterial lymphadenitis in adult is based on clinical diagnosis and chemotherapy. Biopsy is reserved for patients who fail to respond, including the small portion of patients in whom lymph nodes enlarge during chemotherapy. Lymph nodes can appear a fresh or enlarge during or after treatment, but they usually resolve spontaneously.

Thirty-one patients with obstructive sleep apnea syndrome underwent uvulopalatopharyngoplasty (UPPP). After three months, the average apnea/hypopnea index (AHI) decreased from 352.2 +/- 138.2 (mean +/- SD) to 182.2 +/- 140.4 episodes/hr and the duration of oxygen desaturation (less than 85%) decreased from 38.4 +/- 48.6 to 13.2 +/- 25.8 minutes. Although only 51.6% patients had a reduction of AHI greater than 50%, a questionnaire study revealed that most patients had subjective improvement of clinical symptoms and only mild complications were noted. We tried to find out the correlation between the efficacy of UPPP and the severity of obstructive sleep apnea and obese but failed. It is concluded that UPPP is the treatment of choice for obstructive sleep apnea syndrome in selective patients.

Lymphangioleiomyomatosis (LAM) is a rare disease of women of childbearing age in which there is hyperplasia of atypical smooth muscle along lymphatics in the lung, thorax, and abdomen. Since Lautenbacher's first description in 1918, less than 100 cases of Bourneville's tuberous sclerosis (BTS) with involvement of the lungs have been reported. Their clinical, radiologic and pathologic manifestations are so strikingly similar to those of pulmonary lymphangioleiomyomatosis (PLM) that some authors have considered PLM to be a form fruste of BTS. We present a case of PLM with clinical pictures of dermatologic stigmata and kidney angiomyolipoma of tuberous sclerosis but free of neurologic symptoms. After the development of a recurring spontaneous pneumothorax, she had a downhill course and progressive pulmonary functional defect.

Seventy sputum specimens from chronic obstructive pulmonary disease (C.O.P.D.) with secondary infection patients and 50 sputum specimens from C.O.P.D. patients without infection were cultured on blood agar plate, eosine-methylene blue agar plate, chocolate agar plate and selective medium chocolate agar plate. Haemophilus species was isolated from 20 specimens from C.O.P.D. with secondary infection patients. The isolation rate was 28.5%. Eight strains could produced beta-lactamase and were resistant to ampicillin (40%). One strain was resistant to ampicillin though without beta-lactamase production.

The differential diagnosis of newly developed pulmonary infiltrate in CXR film of immunocompromised host including infection, neoplasm, pulmonary edema, pulmonary hemorrhage, cytotoxic drug induced pneumonitis, radiation pneumonitis and transfusion induced pneumonitis. If clinical course changed rapidly and the patient had fever, cough and dyspnea, then, opportunistic infection should be considered at first. Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL), brushing and trans- bronchial biopsy (TBLB) will give most of informations. If the patient had hypoxemia, high, flow O 2 (even pure O 2) should be given to the patient and pulse oximeter used to monitor his state of oxygenation continuously. BAL should be done at first for its high yield in infectious cases. If the condition allowed us to perform more procedures, brushing and TBLB should also be considered. We present one case of polyarteritis nodosa with Pneumocystis carinii pneumonia after longterm endoxan and corticosteroid treatment. This patient had typical history and diagnostic procedures.