[Detection of aspiration of nasopharyngeal secretion and the relationship between the aspiration of nasopharyngeal secretion and the incidence of pneumonia].

OBJECTIVE: To establish a method to detect aspiration of nasopharyngeal secretion and to explore the relationship between aspiration of nasopharyngeal secretion and pneumonia. METHOD: Thirty-two patients with pulmonary infection [(30 males, 2 females; mean age (73 ± 8) years] were recruited from the First Affiliated Hospital of Guangzhou Medical University during the period between June 2014 and August 2014, and 9 age-matched healthy volunteers [(7 males, 2 females; mean age (73 ± 6) years] as the control group. A dose of 74.0 MBq 99Tc(m)-sulfur colloid was diluted in 12 ml of saline, and then the mixture was dripped into the nasal pharynx of volunteers by 24 ml/h. Dynamic imaging from the mouth to the stomach was acquired by SPECT/CT. Two experienced physicians assessed all examination results and reached consensus for final diagnosis. Radioactivity detected at either the bronchi or within the lung fields was reported as positive for aspiration. RESULTS: In the test group, 19 of 32 patients with pneumonia had a history of suffering from upper respiratory tract symptoms such as runny or blocked nose, and 21 of 32 patients were detected to have aspiration. However, none of the healthy people had aspiration (χ² = 9.624, P=0.002). In 21 patients with pneumonia, 14 showed respiratory aspirations in areas corresponding to the lesions, i.e. bilateral lungs, the right lung and the left lung in 6/10, 6/8, and 2/3 cases respectively (P=0.067). CONCLUSION: 99Tc(m)-sulfur colloid imaging is effective to detect the aspiration of nasopharyngeal secretions in the elderly people. Besides, the incidence rate of aspiration in the patients was higher than that in healthy people, which suggests that aspiration of nasopharyngeal secretion is the cause of pulmonary infection.

Pulmonary lesions associated with sputum culture-positive actinomycetes: report of one case.

Pulmonary actinomycosis (PA) is a rare subacute or chronic infectious disease. As simple culture of Actinomyces in BAL, as with sputum, may represent colonization, the diagnosis of PA relies on pathological examination. The preferred treatment is long-term, high-dose penicillin. A 6-12-month-course of antibacterial treatment is the rule in extended PA, although the optimal duration of treatment has not been investigated through randomized trial. In this article, we report a case presented with slowly-progressing pulmonary cavitary lesions. Actinomyces odontolyticus was detected in sputum specimen harvested by tracheoscopy. The clinical diagnosis was PA, which gradually improved with prolonged treatment of penicillin and ornidazole. This is followed by a discussion of diagnosis and treatment, especially in terms of treatment.

[Expiratory flow limitation detected by negative expiratory pressure in patients with chronic obstructive pulmonary disease].

OBJECTIVE: To evaluate the relationship between expiratory flow limitation (EFL) and chronic dyspnea and the effect of bronchodilator on EFL in patients with chronic obstructive pulmonary disease (COPD). METHODS: Thirty-three ambulatory patients with COPD (46 - 78 yrs; male 31, female 2) were included in this study. The severity of chronic dyspnea was rated according to the dyspnea scale proposed by the Medical Research Council (MRC). EFL was measured by applying negative pressure at the mouth during tidal expiration before and after bronchodilation test (inhalation of 400 microg salbutamol). RESULTS: EFL was detected in 12 (36%) of the 33 COPD patients in both seated and supine positions and in 11 (33%) only in supine position. There was a significant difference in the percent predicted forced expired volume in one second (FEV(1%)pred) between subgroups of the patients with or without EFL (t = 7.601, P < 0.01). The mean values of FEV(1%)pred in non-EFL group and EFL group was (66 +/- 16)% and (31 +/- 10)%, respectively, and the value was lowest in patients who showed EFL both in seated and supine positions [(24 +/- 7)%]. Both three-point EFL and five-point EFL were significantly correlated with FEV(1) (r = -0.836 and -0.818, respectively, all P < 0.01). There was a significant correlation between MRC dyspnea scale and three-point EFL and five-point EFL (r = 0.903 and 0.912, respectively, all P < 0.01). In the multiple regression analysis, five-point EFL was a better predictor of dyspnea than FEV(1) (regression coefficient was 0.679 and -0.265, respectively, P < 0.01 and 0.029, respectively). EFL persisted after salbutamol in all of the 23 patients with EFL under baseline conditions. CONCLUSIONS: EFL as measured by negative expiratory pressure (NEP) technique may be more useful in the evaluation of dyspnea in COPD patients than routine lung function measurements. The EFL in COPD patients is irreversible after bronchodilator administration.

[The relationship between mouth pressure or tracheal pressure and esophagus pressure and diaphragmatic pressure].

OBJECTIVE: To investigate the relationship between mouth pressure (Pmo) or tracheal pressure (Ptr) and esophagus pressure (Pes) or transdiaphragmatic pressure. METHODS: Seventeen patients were involved in the study. Maximal inspiratory pressure (MIP), maximal transdiaphragmatic pressure (Pdi(max)), maximal esophagus pressure (Pes(max)), twitch mouth pressure (TwPmo), twitch transdiaphragmatic pressure (TwPdi) and twitch esophagus pressure (TwPes) were measured before narcotization as a normal procedure for the abdominal operation and twitch tracheal pressure (TwPtr(nar)), twitch esophagus pressure (TwPes(nar)) and twitch transdiaphragmatic pressure (TwPdi(nar)) were dynamically monitored during narcotization. RESULTS: (1) The correlation coefficient (r) values between Pdi(max) and MIP, TwPdi and TwPmo, TwPdi(nar) and TwPtr(nar), Pes(max) and MIP, TwPes and TwPmo, TwPes(nar) and TwPtr(nar) were 0.976 +/- 0.030, 0.816 +/- 0.155, 0.923 +/- 0.446, 0.981 +/- 0.185, 0.829 +/- 0.168 and 0.955 +/- 0.292, respectively. (2) The coefficient variation (CV) of MIP, Pes(max), Pdi(max), TwPmo, TwPes and TwPdi were (14.2 +/- 4.7)%, (15.2 +/- 4.3)%, (15.5 +/- 4.1)%, (30.4 +/- 15.9)%, (10.8 +/- 5.1)% and (9.9 +/- 4.0)%, respectively. The CV of TwPmo was the highest (compare with others, all P < 0.05) and that of TwPes and TwPdi was the lowest (compare with others, all P < 0.05). There was no significant difference among MIP, Pes(max) and Pdi(max) (P > 0.05). (3) The r value between the changing values of TwPtr(nar) and TwPdi(nar) or TwPes(nar) during narcotization were 0.839 or 0.894 (P = 0.000, respectively). CONCLUSION: The measurement of MIP and TwPmo should be repeated and the highest value should be chosen in order to reduce the possibility of underestimating the function of diaphragm, which could be dynamically monitored by TwPtr(nar).

Twitch mouth pressure and disease severity in subjects with COPD.

INTRODUCTION: Patients with COPD have impaired respiratory muscle strength. Twitch mouth pressure (Ptw,m) in response to magnetic stimulation of the cervical nerve has been suggested to clinically reflect inspiratory muscle strength. However, studies on Ptw,m values and their relationship with disease severity are limited. Thus, we tested the Ptw,m values of subjects with COPD and investigated the relationship of these values with disease severity. METHODS: We recruited 75 COPD patients and 63 age-matched controls. All participants were tested for Ptw,m, sniff nasal pressure (SNIP), and maximum static inspiratory mouth pressure (PImax ); the BODE (body mass index, air flow obstruction, dyspnea, exercise capacity) index was evaluated for overall severity assessment and the 6-min walk distance (6MWD) was used to determine the exercise capacity of subjects with COPD. RESULTS: Subjects with COPD had markedly lower Ptw,m values compared with the controls (10.00 ± 2.17 vs 13.66 ± 2.20 cm H2O for males, 8.83 ± 0.89 vs 11.81 ± 1.98 cm H2O for female; each with P < .001). The Ptw,m values decreased with increasing COPD severity, and similar trends were observed in the SNIP and PImax values. Regression correlation analysis showed that Ptw,m values were significantly correlated inversely with the BODE index (R = 0.65, P < .001) but positively correlated with 6MWD (R = 0.59, P < .001) in the COPD group; the SNIP values of subjects with COPD were also correlated inversely with their BODE index (R = 0.49, P < .001) but positively correlated with their 6MWD (R = 0.33, P < .005). CONCLUSIONS: Ptw,m values are 26.8% lower in male subjects with COPD and 25.3% lower in female subjects with COPD compared with the controls. The Ptw,m values of subjects with COPD decrease with increasing disease severity. Ptw,m was better correlated with the BODE index and exercise capacity than SNIP and PImax , which suggests that Ptw,m more accurately reflects the overall severity and burden of COPD.

Use of twitch mouth pressure to assess diaphragm strength in patients with chronic obstructive pulmonary disease.

This study was undertaken to determine whether twitch mouth pressure (TwPmo) can reliably assess diaphragm strength in patients with chronic obstructive pulmonary disease (COPD) using fully automatic trigger techniques. Fifteen patients with COPD were recruited. TwPmo, twitch oesophageal pressure (TwPes) and twitch transdiaphragmtic pressure (TwPdi) were generated by phrenic nerve stimulation and were measured using an inspiratory flow trigger (40 ml/s, Experiment 1) using an inspiratory pressure trigger (-5 cmH2O, Experiment 2) and using no trigger at functional residual capacity (Experiment 3). The correlation between TwPmo and TwPes was as follows: r=0.832; P<0.0001 (Experiment 1), r=0.900; P<0.0001 (Experiment 2); there was no significant correlation in Experiment 3. A Bland-Altman plot of the difference between TwPmo and TwPes showed the limits of agreement in Experiment (1) bias (range) 0.18 cmH2O (-2.05 to 2.41) and Experiment (2) bias (range) 0.32 cmH2O (-1.69 to 2.32). Measuring TwPmo using a fully automatic technique is a simple and convenient method for assessing diaphragm strength.