支气管哮喘并发肺癌的联合手术治疗

目的 探讨支气管哮喘患者并发肺癌进行联合手术的可行性。方法 在根治性切除肺部肿瘤的同时,采用肺门神经彻底切断术治疗支气管哮喘。１例右上叶周围型肺癌,行右上肺叶切除、淋巴结清扫的同时作同侧肺门迷走神经和交感神经的彻底切断。另１例左上肺巨大中心型肺癌,行全肺切除后,摘出可保留的左下肺叶,采用自体肺移植技术将其重植于原左肺上叶位置。结果 随访至１９９９年１１月底,２例已分别存活６年８个月及１７个月。术后     

Necrotizing colitis

Seven patients with necrotizing colitis treated surgically are presented. Old age, cardiac failure, arteriosclerosis, mental disease, constipation, ischemic colonic stricture, bronchial asthma, rheumatoid arthritis, and previous radiation therapy are suggested as predisposing factors. Symptoms and signs were those of an acute abdominal catastrophe with peritonitis and peripheral collapse. The incorrect preliminary and operative diagnoses in this series point to a lack of familiarity with this disease entity.After necessary resuscitation, laparotomy was immediately performed, and an enormously distended colon was found resulting from massive necrosis in six patients and imminent necrosis in one. No evidence of occlusion of the blood supply of the mesenteric vessels was seen. The entire colon was involved in two cases. The ischemic cause was obvious on the basis of clinical, radiologic, operative, and/or pathologic appearance of the lesions.Five patients survived. Wide excision of the involved colon and delayed reanastomosis are recommended in the surgical treatment.     

The blood enzymatic antioxidative potential in bronchial asthma patients

This study aims at assessing the ability of asthma patients to defend themselves against the noxious effects of oxidative stress, known being the inflammatory nature of this disorder. As the anti-radical defence ability of the body is reflected by the antioxidative potential of blood and tissues, our study was based on the determination of the activity of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and CAT/SOD and GPx/SOD ratios in the blood. Except for SOD, the activity of which was lower in asthma patients by -34.08%, CAT and GPx had values increased by +32.18%, respectively, with a resulting increase of CAT/SOD and GPx/SOD ratios. Our data, demonstrating a change in per-oxidants/antioxidants balance in favour of the first ones, seem to suggest that in the treatment of bronchial asthma the association of some compounds with antioxidants effects would be beneficial.     

Increased blood carboxyhaemoglobin concentrations in inflammatory pulmonary diseases

BACKGROUND: Exhaled carbon monoxide has been reported to increase in inflammatory pulmonary diseases and to be correlated with blood carboxyhaemoglobin (Hb-CO) concentration. A study was undertaken to determine whether arterial blood Hb-CO increases in patients with inflammatory pulmonary diseases. METHODS: The Hb-CO concentration in arterial blood was measured with a spectrophotometer in 34 normal control subjects, 24 patients with bronchial asthma, 52 patients with pneumonia, and 21 patients with idiopathic pulmonary fibrosis (IPF). RESULTS: The mean (SE) Hb-CO concentrations in patients with bronchial asthma during exacerbations (n=24, 1.05 (0.05)%), with pneumonia at the onset of illness (n=52, 1.08 (0.06)%), and with IPF (n=21, 1.03 (0.09)%) were significantly higher than those in control subjects (n=34, 0.60 (0.07)%) (mean difference 0.45% (95% confidence interval (CI) 0.23 to 0.67), p<0.01 in patients with bronchial asthma, mean difference 0.48% (95% CI 0.35 to 0.60), p<0.0001 in patients with pneumonia, and mean difference 0.43% (95% CI 0.26 to 0.61) p<0.001 in patients with IPF). In 20 patients with bronchial asthma the Hb-CO concentration decreased after 3 weeks of treatment with oral glucocorticoids (p<0.001). In 20 patients with pneumonia the Hb-CO concentration had decreased after 3 weeks when patients showed evidence of clinical improvement (p<0.001). The values of C-reactive protein (CRP), an acute phase protein, correlated with Hb-CO concentrations in patients with pneumonia (r=0.74, p<0.0001) and in those with IPF (r=0.46, p<0.01). In patients with bronchial asthma changes in Hb-CO concentrations were significantly correlated with those in forced expiratory volume in 1 second (FEV(1)) after 3 weeks (r=0.67, p<0.01). Exhaled carbon monoxide (CO) concentrations were correlated with Hb-CO concentrations (n=33, r=0.80, p<0.0001). CONCLUSIONS: Hb-CO concentrations are increased in inflammatory pulmonary diseases including bronchial asthma, pneumonia, and IPF. Measurement of arterial Hb-CO may be a useful means of monitoring pulmonary inflammation.     

Surgical treatment of bronchial asthma

Methods of surgical treatment of bronchial asthma (BA) are classified as first generation (glomectomy, gangliectomy, vagotomy, pulmonary roots denervation), second generation (implantation of neurostimulators of sinocarotid, diaphragmal nerves, vagus, sympathic trunks), third generation (implants of programmed microchips). 7-year experience of surgical treatment with second generation methods in 125 patients with BA and experience of third generation methods use are summarized. Methods of second and third generations are most promising, permit to prevent and to cure asphyxia attack without drugs--with electrostimulation of vegetative system structures by impulse current (30-150 Hz, 0.01-0.1 ms, 0.5-2.0 V). New methods increase remission period more than 2 times, reduce drug daily requirement not less than 2 times. New methods can be used with traditional drug therapy and don't lead to dangerous for life complications. From first generation methods of BA's surgical treatment, only glomectomy and pulmonary roots denervation can be performed on serious demand.     

Relation between bronchial responsiveness to inhaled leukotriene D4 and markers of leukotriene biosynthesis

BACKGROUND: While clinical trials with antileukotrienes have shown overall beneficial effects in asthma, the factors that determine leukotriene dependent asthma are still unclear. A study was undertaken to determine whether or not leukotriene responsiveness in the airways correlates with endogenous leukotriene biosynthesis. METHODS: Bronchial responsiveness to leukotriene (LT) D4 was assessed as PD20FEV1 in 20 subjects with mild asthma and 10 healthy controls, and compared with bronchial responsiveness to methacholine and two global measures of leukotriene production-urinary LTE4 and ex vivo production of LTB4 in whole blood. RESULTS: In patients with asthma the bronchoconstrictor activity of LTD4 was about 1300 times greater than methacholine (geometric mean PD20 0.69 nmol v 887 nmol). Those who were most responsive to LTD4 were relatively less responsive to methacholine (p<0.01). There was, however, no correlation between bronchial responsiveness to LTD4 and urinary LTE4 or blood ex vivo LTB4 levels in asthmatic subjects or healthy controls. Subjects with asthma treated with inhaled corticosteroids produced higher levels of LTB4 (p<0.05). CONCLUSIONS: General measures of leukotriene production cannot predict bronchial responsiveness to LTD4. The unique bronchoconstrictive potency of LTD4 on human airways may relate to the locally regulated expression of the cysteinyl LT1 receptor.     

Disappearance of wheezing during epidural lidocaine anesthesia in a patient with bronchial asthma.

BACKGROUND AND OBJECTIVES: Local anesthetics in blood absorbed from the epidural space attenuate bronchial hyperreactivity to chemical stimuli. However, it is not documented whether local anesthetics at clinically relevant concentrations improve active wheezing in patients with bronchial asthma. CASE REPORT: We managed a 60-year-old man with bronchial asthma and active wheezing under continuous epidural anesthesia using plain lidocaine. The wheezing gradually diminished 20 minutes after the epidural injection of 13 mL 2% lidocaine and completely disappeared over 155 minutes during continuous epidural injection of 2% lidocaine (6 mL/h). The plasma concentrations of lidocaine in arterial blood during the epidural anesthesia ranged from 2.5 to 3.9 microg/mL. Wheezing reappeared 55 minutes after termination of the continuous epidural injection of lidocaine. The plasma concentration of lidocaine at this time was 1.9 microg/mL. CONCLUSIONS: At clinically relevant concentrations, lidocaine in the blood absorbed from the epidural space may improve bronchospasm in patients with bronchial asthma.     

Effects of ranitidine treatment on patients with asthma and a history of gastro-oesophageal reflux: a double blind crossover study.

Forty eight patients with moderate to severe asthma were enrolled in a double blind crossover study designed to evaluate the effects of ranitidine treatment, 150 mg twice daily for four weeks, on gastro-oesophageal reflux, asthma control, and bronchial reactivity. All 48 had a history of reflux symptoms and 27 had in addition reflux associated respiratory symptoms. Thirty two patients had objective evidence of acid reflux on 24 hour pH monitoring (pH of less than 4 for more than 1% of the 24 hours) and 27 patients had a positive result in the acid perfusion test. Reflux symptoms were significantly improved after ranitidine treatment. Ranitidine treatment was associated with modest improvements in nocturnal asthma and daily use of inhaled bronchodilator drugs but there was no significant change in bronchial reactivity, lung function, peak flow, or the number of eosinophils in the blood. Comparisons between the effect of ranitidine treatment on asthma control were performed between patients with and without a history of reflux associated respiratory symptoms, with and without a positive result in the acid perfusion test, and with and without objective evidence of gastro-oesophageal reflux. A history of reflux associated respiratory symptoms was the only factor that predicted an improvement in asthma control after ranitidine treatment. These results indicate that antireflux treatment will produce only small improvements in asthma control in asthmatic patients with a history of gastro-oesophageal reflux.     

Clinical features of medical pneumomediastinum.

PURPOSE: The clinical features of pneumomediastinum are clarified. METHODS: Eight patients with pneumomediastinum, caused by other than trauma or operative, diagnostic, or therapeutic trouble (medical pneumomediastinum), were studied retrospectively. RESULTS: There were seven men and one woman with an average age of 17.5 years. The incidence was about 1:320 in thoracic surgical inpatients. The causes were bronchial asthma in three patients, physical exertion in one, and forced swallowing in one. There were three spontaneous cases. The chief complaints were dyspnea in five patients including three patients with bronchial asthma, chest pain in two, and pharyngeal pain in one. Subcutaneous emphysema was observed in all patients. Hamman's sign was audible in only one patient. Roentgenologically, subcutaneous emphysema was observed in all patients. Pneumomediastinum parallel to the heart was observed in five patients. The continuous diaphragm sign was detected in three patients. Five patients were prohibited from eating and drinking excluding those with pneumomediastinum due to bronchial asthma, considering the esophageal origin. Prophylactic antibiotics were prescribed for all patients. Pneumomediastinum improved within 7 days in all patients. The mean length of hospitalization was 7.8 days, ranging from 4 to 13 days.CONCLUSION: In consideration of air of the esophageal origin, non per oral was prescribed. With the prevention of mediastinitis using antibiotics, all patients recovered. Emergency endoscopic examination was unnecessary.     

Plasma cortisol and the use of hydrocortisone in the treatment of status asthmaticus

Cayton, R. M., and Howard, P. (1973).Thorax, 28, 567-573. Plasma cortisol and the use of hydrocortisone in the treatment of status asthmaticus. Plasma cortisol, intravenous synacthen tests of adrenal function, arterial blood gases, and spirometric tests of respiratory function were measured in patients with bronchial asthma during clinically stable periods and during status asthmaticus. Intravenous hydrocortisone was given in a predetermined manner in an attempt to measure the effective dose for treatment. The presence of adrenal suppression did not influence the severity of the attack nor the amount of hydrocortisone required for treatment. Clinical signs, arterial oxygen tension, forced expiratory volume, forced vital capacity, pulse rate, and blood pressure gave no indication as to which patients would respond to a single injection of aminophylline or require repeated hydrocortisone for days or weeks. The results are discussed in relation to the mechanism of bronchial asthma.     

沙美特罗替卡松在哮喘治疗中的控制作用

目的研究沙美特罗替卡松粉吸入剂治疗支气管哮喘的临床安全性及疗效。方法选择2009年2～10月笔者所在医院110例支气管哮喘患者,随机分成治疗组和对照组,每组各55例。治疗组患者选择沙美特罗替卡松粉吸入剂治疗;对照组患者只选择丙酸氟替卡松进行治疗,观察两组患者药物反应和症状改善情况,比较两组患者咳嗽、喘息及呼吸困难消失时间。结果治疗组患者咳嗽、喘息及呼吸困难消失时间都比对照组患者短,差异有统计学意义（P〈0.05）;治疗组用药后各项肺功能改变率与对照组比较,差异有统计学意义（P〈0.05）。结论应用沙美特罗替卡松粉吸入剂治疗哮喘,不但治疗效果好而且使用安全,值得临床上推广应用。     

Therapeutic tactics in inflammatory diseases of the gallbladder in patients with bronchial asthma

The authors describe curative methods of treatment of inflammatory diseases of the gallbladder in 12 patients with bronchial asthma. Sanitation of the surgical infection focus (cholecystectomy) improves the clinical course of bronchial asthma, positively influences the immune status of the patients.     

Effect of hyperthyroidism on bronchial reactivity in non-asthmatic patients.

Thyrotoxicosis may be associated with deterioration in asthma. To determine whether bronchial reactivity to histamine is increased in hyperthyroidism 10 thyrotoxic non-asthmatic patients were assessed before and after treatment of their thyrotoxicosis. No significant change in bronchial reactivity was found after treatment.     

Exposure to external pain in the treatment of bronchial asthma

Immediate results of treatment of 55 patients with bronchial asthma of different severity by a method of the exposure to external pain are described. The method is shown to be efficient in bronchial asthma of any genesis, its use to be promising for overcoming any drug (even hormonal) dependence.     

Significance of radiological examination of the lungs in determining the extent of surgery in patients with bronchial asthma

Indications for various types of operative intervention in 411 patients (among 986 patients who were examined in a specialized pulmonological department) were determined according to the degree of functional and morphological changes of the respiratory tract by means of complex radiological examination together with other modern methods (radioisotope, immunological, bronchological, etc.) for examination of the bronchopulmonary system in bronchial asthma.     

氨茶碱联合盐酸氨溴索治疗小儿支气管哮喘临床效果观察

目的探讨氨茶碱联合盐酸氨溴索治疗小儿支气管哮喘的治疗效果。方法自2011年1月～2013年12月间我院门诊共收治146例小儿支气管哮喘患者,根据用药情况随机分为两组各73例,两组患者采用相同的对症治疗方法,此外,对照组给予糖皮质激素静滴及氨茶碱,观察组在对照组的基础上联合盐酸氨溴索治疗,共治疗4周,比较两组临床疗效、喘憋消失时间、喘鸣音消失时间、咳嗽消失时间。结果观察组总有效率为93．15％,对照组为72．6％,两组总有效率差异有统计学意义（P〈0．05）。观察组喘憋消失时间、喘鸣音消失时间及咳嗽消失时间与对照组比较明显较短,差异有统计学意义（P〈0．05）。结论氨茶碱联合盐酸氨溴索治疗小儿支气管哮喘有较好的临床效果,安全性较高,可以在临床推广应用。     

诱导痰嗜酸粒细胞检查在支气管哮喘患者管理中的应用价值

目的探讨诱导痰嗜酸粒细胞（EOS）检查在支气管哮喘患者管理中的应用价值。方法选择我院2012～2013年呼吸科收治的90例支气管哮喘患者的资料,患者经治疗,根据哮喘控制测试及肺功能按全球哮喘防治倡议,均达到停药标准,同时患者行诱导痰嗜酸性粒细胞检查,根据患者嗜酸性粒细胞含量分为观察组（嗜酸性粒细胞〉1％,50例）及对照组（嗜酸性粒细胞〈1％,40例）,随访4周,比较两组患者控制哮喘测试及肺功能指标。结果观察组患者ACT测试达标率低、肺功能指标差,与对照组患者比较差异有统计学意义。结论EOS是导致哮喘的主要炎性细胞,诱导痰EOS可作为支气管哮喘患者病情监测的重要指标。     

Patellar pain treated by neurotomy

The mechanism of patellar pain is still not fully understood. Many operative procedures have been proposed, but so far no single technique has been successful. Under the impression that some of the pain-relieving effect by operative treatment is due to partial denervation of the patella, a medial denervation of the patella was performed in 17 patients (20 knees), mean age 24 years, with patellar pain syndrome. At the follow-up only 11 knees were free of symptoms or had improved, and the authors conclude that though comparable with other surgical methods, medial neurotomy is not sufficient to eliminate the pain in patients with patellar pain syndrome.     

硫酸沙丁胺醇口服液对儿童支气管哮喘的治疗效果

目的：探讨硫酸沙丁胺醇口服液对儿童支气管哮喘的治疗效果。方法2013年4~12月在河南省开封市中心医院门诊接受治疗,经肺功能检查有可逆性气道阻塞,支气管舒张试验阳性的轻、中度哮喘急性发作患儿100例,将其随机分为研究组（n=50）和对照组（n=50）,两组患儿均给予基础治疗,观察组在上述基础治疗上再给予硫酸沙丁胺醇口服液治疗,所有患儿每天早晚监测血压,并记录2周后的哮喘日间与夜间症状评分,晨间用力肺活量（FVC）、第一秒用力呼出量（FEV1）、最大呼气流量占正常预计值之比（PEF%）,并记录治疗效果及不良反应。结果研究组治疗2周后哮喘日间症状评分、哮喘夜间症状评分、临床疗效评分分别为（0.11±0.00）、（0.03±0.01）、（0.04±0.00）分,均低于对照组,差异有统计学意义（P＜0.05）。 FVC、FEV1、PEF分别为（82.0±5.6）%、（84.2±5.2）%、（82.3±3.3）%,均较对照组升高,差异均有统计学意义（均P＜0.05）。两组不良反应事件发生率分别为4.0%、4.0%,组间比较差异无统计学意义（P＞0.05）。结论硫酸沙丁胺醇用于儿童支气管哮喘效果明显,可改善哮喘轻中度急性发作的临床症状及肺功能,缓解支气管平滑肌痉孪,解除喘息,安全性高,可用于治疗儿童支气管哮喘。     

Mechanical and conventional manual sutures of the bronchial stump. A comparative study of 298 surgical patients.

A U.S.-made TA-30 model stapling device was utilized to close the bronchial stump in 146 patients, while conventional manual suturing with chromic catgut was performed for the same purpose in 152 patients. The two groups were comparable in respect of pre-operative status and operative diagnosis. Patients, in whom the stapler was utilized, showed a decreased incidence of bronchial fistula (1% vs. 3%) and empyema without fistula (1% vs. 3%). The stapler, compared with conventional manual sutures, allows a simpler and swifter suture of the bronchial stump, reduces the contamination of the operative field, achieves uniform and tighter closure of the bronchus, leaves a better preserved terminal blood perfusion of the stump and utilizes a more tolerated sewing material with less resultant tissue inflammation.