Investigation of pulmonary hemodynamics and chest X-ray findings in hypercapnic patients with pulmonary tuberculosis sequelae]

We investigated pulmonary hemodynamics and chest X-ray findings to explore pathophysiological significance of chronic hypercapnia in patients with pulmonary tuberculosis sequelae. One hundred and seven patients underwent examinations of blood gases and right cardiac catheterization. The patients were divided into two groups, according to arterial carbon dioxide tension under room air breathing (PaCO2). Group I (n = 35) was defined as 45 Torr or lower of PaCO2, and Group II (n = 72) was the hypercapnic group whose PaCO2 was over 45 Torr. In addition, spirometry was done in 34 patients of Group I and 68 of Group II. First, the values of blood gases, spirometry and pulmonary hemodynamics were compared between the two groups. Secondly, between 22 of Group I and 50 of Group II, the values of pulmonary arteriolar resistance (PAR) before and after 100% oxygen breathing for 10 minutes were compared. These comparisons were made by exploratory data analysis. Lastly, we described in all cases with five items of chest X-ray findings and the extent of each finding we had defined. The items were emphysematous change; fibrosis, bronchiectasis, and/or cavity (hereafter abbreviated as "fibrosis"); lung resection and/or atelectasis; pleural thickening; and thoracoplasty. We explored the items of X-ray findings which may relate to hypercapnia by ridit (abbreviation for "relative to an identified distribution") analysis. The results were as follows. (1) Hypercapnic patients tended to have severer restrictive ventilatory impairment and hypoxemia. Under an even level of arterial oxygen tension (PaO2), tissue oxygenation was not poorer in Group II than in Group I. (2) Hypercapnic patients tended to have more unfavorable pulmonary hemodynamics. More than half of them had pulmonary hypertension defined as 20 mmHg or higher of pulmonary artery mean pressure (PAm). Under an even level of PaO2, PAm was higher in Group II. Although 34 patients of Group II showed PaO2 over 60 Torr, 23 of them had pulmonary hypertension. (3) PAR after oxygen breathing was more likely to decrease in Group II than in Group I. (4) As any mean ridit was standardized and adjusted to 0.5 in Group I, the maximum was the mean ridit of "pleural thickening" (= 0.67), next "fibrosis" (= 0.65) in Group II. The above two items of X-ray findings, in which each mean ridit was higher than in any other item, were more influential on hypercapnia. We conclude as follows. (1) Pulmonary hypertension is severer in hypercapnic patients with pulmonary tuberculosis sequelae; it may be mainly attributable to hypoxic pulmonary vasoconstriction. (2) An important cause of chronic hypercapnia may be pathological changes such as "pleural thickening" and "fibrosis" seen on the radiogram.     

Noninvasive positive pressure ventilation in patients with acute exacerbations of pulmonary tuberculosis sequelae]

To clarify whether noninvasive positive pressure ventilation (NPPV) is effective in patients with acute exacerbations of pulmonary tuberculosis sequelae (PTS), 50 PTS patients (66 episodes) without long-term domiciliary noninvasive ventilation were studied, retrospectively. The average values (SD) of their pulmonary function tests and arterial blood gases were as follows; %predicted VC = 31.4 (8.4)%, pH = 7.29 (0.06), PaCO2 = 91.8 (19.7) mmHg, and PaO2 = 64.2 (20.3) mmHg. The probability of avoiding endotracheal intubation and recovering from an acute exacerbation with NPPV (NPPV success rate) was 92% as a whole. NPPV success rates according to the causes of deterioration were as follows; 96% in 26 episodes with only a simple right heart failure, 93% in 29 episodes with airway infectious diseases, 75% in eight episodes with pneumonia and/or acute respiratory distress syndrome. Moreover, the NPPV success rate of eight episodes in coma or semicoma was 88%. Most patients were treated in respiratory wards rather than intensive care units. Out of 46 patients who recovered from an acute exacerbation, 41 finally received domiciliary NPPV. In facilities where staff are well-trained for an acute NPPV, patients with exacerbations of PTS can be treated as successfully with NPPV as patients with COPD.     

The rehabilitation of patients with pulmonary tuberculosis in combination with chronic nonspecific lung diseases]

One hundred and fifty five patients with pulmonary tuberculosis concurrent with chronic nonspecific pulmonary diseases (most commonly chronic obstructive bronchitis) were examined. The analysis of the obtained material has indicated that with a combined affection, an early development of respiration and blood circulation dysfunction is observed. In addition, some patients often continue to work in contraindicated labor conditions, which leads to serious disability with low rehabilitative potentialities. To increase the effectiveness of rehabilitation, it is necessary to improve the system of primary prevention of both nosologic entities.     

Effects of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis

Background and objective:   Although pulmonary rehabilitation is effective for patients with COPD, its efficacy in patients with IPF is unknown. The purpose of this study was to evaluate the effects of pulmonary rehabilitation in IPF.
Methods:   Thirty patients diagnosed with IPF, according to the consensus statement, were randomly assigned to the rehabilitation group or the control group. The pulmonary rehabilitation mainly consisted of a 10-week programme of exercise training. Pulmonary function, blood gas analysis, 6MWD, dyspnoea rating with the baseline dyspnoea index and health-related quality of life score on the St George's Respiratory Questionnaire were evaluated at baseline and after the programme.
Results:   Assessment of efficacy was carried out on 13 patients who completed the programme and 15 patients in the control group. There were no significant effects of the programme on measures of pulmonary function, values of arterial blood gas analysis or dyspnoea rating. Although there were some differences in the baseline 6MWD and total health-related quality of life score which were not statistically significant, marked improvements were observed in the 6MWD (mean difference 46.3 m (95% CI: 8.3–84.4), P  < 0.05) and the total health-related quality of life score (−6.1 (95% CI: −11.7 to −0.5), P  < 0.05).
Conclusions:   Pulmonary rehabilitation improves both exercise capacity and health-related quality of life in patients with IPF.     

Doppler-echocardiographic examination of patients with pulmonary tuberculosis]

Echocardiography of 110 newly diagnosed patients with pulmonary tuberculosis was undertaken to find anatomic changes and certain blood flow indices in the right heart. These changes were represented by an enlarged chamber of the left ventricle in over half of the patients and that of the left atrium in 1/3 of them (including myocardial hypertrophy also detected most commonly in the ventricular septum in 1/3 of the cases); fibroplastic changes in the anterior wall and ventricular septum; and induration of the cusps and semilunums of the tricuspid and pulmonary valves with subvalvular structures in 1/5 of the patients. In addition to hypertrophy of the ventricular septum, an enlarged chamber of the right ventricle and the left atrium was most frequently revealed in patients with primary tuberculous process. Fibroplastic changes in the myocardium plus calcinosis were traced in the majority of the patients with disseminated tuberculosis. Higher blood pressure in the outlet chamber of the right ventricle was mostly observed in patients with intrathoracic lymph nodes and disseminated tuberculosis, elevated pressure largely coinciding with right ventricle and pulmonary artery dilatation.     

Clinical analysis of patients with sequelae of pulmonary tuberculosis undergoing home oxygen therapy

PURPOSE: To clarify the clinical characteristics of patients with sequelae of pulmonary tuberculosis undergoing home oxygen therapy. OBJECTS AND METHODS: We conducted a cross-sectional survey of those with newly-introduced home oxygen therapy for the sequelae of pulmonary tuberculosis from 1998 through 2001, using national hospital network of respiratory diseases. RESULTS: The study subjects were 402 in total (271 men and 131 women), who started the home oxygen therapy at the age ranging between 33 and 100 years (72.2 +/- 8.1 years, mean +/- S.D.). They suffered from pulmonary tuberculosis at the mean age of 37.7 +/- 19.4 years, and the interval leading to oxygen therapy averaged 33.1 +/- 19.1 years. Sixty-eight percent of these patients demonstrated body mass index (BMI) less than 20. Pulmonary function studies revealed the markedly-decreased vital capacity (46.2 +/- 15.0%) as well as reduced FEV1/FVC (68.5 +/- 18.8%). Arterial blood gases measured when home oxygen therapy was introduced showed hypoxemia (Pa(O2), 60.4 +/- 10.7 Torr) with hypercapnea (Pa(CO2), 50.5 +/- 9.4 Torr). The average flow rate of oxygen was 0.94 +/- 0.64 L/min at rest and 1.51 +/- 0.70 L/min on exertion. The patients were divided into two groups; those with surgical intervention including thoracoplasty or lung resection (126 cases, group 1) and those without surgery (148 cases, group 2). The mean age of the patients in the group 1 when home oxygen therapy was started was 72.3 +/- 6.4 years and 71.6 +/- 9.1 years in the group 2, respectively. Subjects in group 1 were more likely suffered from TB in younger age than those in group 2 (28.2 +/- 9.7 vs. 45.4 +/- 21.5 years, p < 0.01), and had the longer duration to initiate domiciliary oxygen therapy (43.0 +/- 10.9 vs. 25.3 +/- 20.3years, p<0.01). The former was also more likely to have lower % VC (p < 0.01), more elevated Pa(CO2) (p<0.05), and lower inspired flow rate of oxygen (p<0.01). There was no significant difference between the two groups with respect to BMI, FEV1/FVC, or CONCLUSION: Our investigation demonstrated that patients with sequelae of pulmonary tuberculosis under oxygen therapy revealed the different clinical course and characteristics regarding the presence or absence of previous surgical intervention.     

Ultraviolet irradiation of blood in patients with pulmonary tuberculosis]

The described methods for ultraviolet blood radiation were used in 80 patients: 51 had tuberculosis of the bronchopulmonary system and 29 nonspecific pulmonary diseases. A marked clinical effect was confirmed by subjective and objective methods. In all cases blood pressure moderately decreased, there was a tendency to hypercoagulation decline, the erythrocyte count and hemoglobin level increased. The microstructure of blood elements studied by a scanning electron microscope showed formation of the rosette-forming structures in the blood and a significant increase in deformed erythrocytes.     

Diagnosis of liver diseases in patients with pulmonary tuberculosis]

The paper deals with the results of detection of liver diseases in 868 patients who underwent examination at the department of pulmonary tuberculosis surgery of the St. Petersburg research institute of phthisiopulmonology. The rate of carriage of hepatitis B surface antigen was 11.05%, while Al/At activity was increased in 30.41% of the cases. Signs of chronic liver disease were diagnosed in 84 patients. Morphological examination verified the diagnosis of chronic hepatitis in 53% of the cases, including 44% of virus etiology; in the rest of patients medicamentous and alcoholic forms were found. Specific liver affections were detected in 16% of the patients, dystrophic and cirrhotic changes in 25%, mainly of medicamentous and alcoholic etiology; in 8% the cause of liver affection remained +non-established.     

Regulatory activity of lymphocytes in patients with pulmonary tuberculosis]

Functional activity of T-lymphocyte suppressors (spontaneous and Con-A induced) has been studied in 17 patients with destructive pulmonary tuberculosis. Patients with ++fibrous-cavernous pulmonary tuberculosis were found to have characteristic disturbances of the regulatory lymphocyte function and a high index of theophylline-resistant E-RFC/theophylline-sensitive E-RFC in the presence of a general reduction of the immunity T-system indices. A higher balance of the regulatory lymphocytes was seen in patients with infiltrative tuberculosis in various disorders of the immunologic parameters.