Typing of Pseudomonas aeruginosa strains in Norwegian cystic fibrosis patients.

OBJECTIVES: Typing of Pseudomonas aeruginosa isolates from Norwegian cystic fibrosis (CF) patients with chronic Pseudomonas lung infection in order to see whether cross-infection might have occurred. METHODS: Isolates from 60 patients were collected during the years 1994-98, and typed by pulsed field gel electrophoresis. RESULTS: Seventy-one strains were identified. One large cluster of identical strains included 27 patients, and 13 smaller clusters of 2-4 patients were found (26 patients). Seven patients had a strain not shared by other patients (private strains). Harboring the main cluster strain was significantly associated with participation in summer camps and training courses (P = 0.004, chi-squared test). There were no associations with regular admissions to hospital (intravenous antibiotic courses) or smaller social gatherings of short duration. Small clusters and private strains were not associated with any of the risk factors. All strains were sensitive to colistin. The minimal inhibitory concentrations were generally lower in Norwegian P. aeruginosa strains compared with isolates from Danish patients. CONCLUSIONS: Our results indicate that cross-infection with P. aeruginosa between cystic fibrosis patients has occurred.

[Radical treatment of bronchial carcinoids with Nd YAG laser]. / Radikalbehandling av bronkiale karsinoider med Nd YAG-laser.

Bronchial carcinoids belong to the malignant bronchial tumours. Most of them grow only by local expansion, but some may behave in a more aggressive way. During the authors' practice with therapeutic bronchoscopies, we have done Nd YAG laser necrotizing of bronchial carcinoids in order to establish the exact localisation of the tumour basis, or to reduce the tumour for palliative reasons. Four of our six patients have shown no sign of residual tumour growth after five years of observation, and their tumour is considered eradicated. In selected patients it is possible to eradicate bronchial carcinoids with laser necrotization, and thus save them from major surgery.

CT and MR imaging of the paranasal sinuses in cystic fibrosis. Correlation with microbiological and histopathological results.

PURPOSE: To compare CT and MR findings of the paranasal sinuses in patients with cystic fibrosis (CF) with microbiology and histopathology. Further, to compare microbiology from the maxillary sinuses, nasopharynx and sputum. MATERIAL AND METHODS: CT and MR imaging of the paranasal sinuses were performed in 10 CF patients. Endoscopy and maxillary sinus aspirates were obtained (guided by the MR findings) and analyzed microbiologically and histologically. Samples from the nasopharynx and sputum were analyzed microbiologically. RESULTS: CT and MR were equal in displaying the extent of soft tissue masses, which at CT were homogeneous, while MR showed heterogeneous signals. MR images also demonstrated circumscribed areas with signal void at the STIR sequence with corresponding high to intermediate signal at the T1-weighted sequence. P. aeruginosa was frequently cultured from these areas which we named the "black hole sign". Maxillary sinus cultures revealed the same bacteria as nasopharynx and sputum cultures combined. CONCLUSION: MR images were superior to CT in differentiating soft tissue masses in the paranasal sinuses in CF patients. Bacteria with potential for specialized iron uptake mechanisms were present in areas with signal void at the STIR sequence. Our hypothesis is that the MR "black hole sign" can be explained by paramagnetic properties related to bacterial agents.

[Chylothorax after pressure pneumothorax]. / Kylothorax etter trykkpneumothorax.

Chylothorax is a pleural effusion caused by leakage of chyle into the pleural cavity. The commonest causes of pleural effusion are trauma to the ductus thoracicus or neoplasms in the mediastinum. The trauma can be iatrogenic or accidental. Chylothorax caused by tension pneumothorax has not previously been reported. We describe a case where this etiology is the most likely explanation of the chylous effusion in our patient.

[Meconium ileus-equivalent in adult patients with cystic fibrosis]. / Mekoniumileus-ekvivalent hos voksne pasienter med cystisk fibrose.

Gastrointestinal complications of cystic fibrosis are becoming more common because patients with cystic fibrosis are living longer. There are 227 cystic fibrosis patients in Norway today, almost half of whom are more than 18 years old. Meconiumileus-equivalent is a complication which increases with age. It is a term used to describe partial or complete intestinal obstruction occurring in patients with cystic fibrosis. It results from abnormally viscid mucofaeculent material in the terminal ileum and right proximal colon. Some patients may experience acute complete obstruction, but most of them suffer from chronic partial obstruction, with recurring colicly abdominal pain and some distension. Of 70 adult cystic fibrosis patients at Aker hospital over a seven year period, 26% had symptoms and signs of this disorder. Conservative treatment is preferable, and surgery should be avoided.

Salmeterol in two different doses in the treatment of nocturnal bronchial asthma poorly controlled by other therapies.

This study compared the efficacy of inhaled salmeterol (SM) 50 micrograms twice a day with SM 100 micrograms once a day (at night) and placebo in patients with poorly controlled nocturnal asthma despite treatment with corticosteroids, oral long-acting bronchodilators, or both. This was a two-center, double-blind, randomized, crossover study with three treatment periods, each of 3 weeks' duration. The first treatment period was preceded by two 1-week run-in periods, and the last treatment period was followed by a 2-week follow-up period. In the three treatment periods, patients received either SM 50 micrograms twice a day, SM 100 micrograms nightly, or placebo, in randomized order. Salbutamol metered-dose inhaler was given as relief medication. Of the 41 randomized patients, 38 were evaluable for more than one treatment period. Efficacy and safety were determined by daily record card data: morning and evening peak expiratory flow rates (PEFR), daytime and nighttime asthma symptom scores, and rescue salbutamol use. At clinic visits, FEV1 and FVC were measured, and the physicians' and the patients' respective assessments of the study mediation were noted. The study showed that the two doses, SM 50 micrograms twice a day and SM 100 micrograms nightly, were equally effective in controlling nocturnal asthma symptoms and were significantly better than placebo. SM was well tolerated, and no unexpected problems were revealed. The adverse events reported during this study were related either to the patient's underlying disease or to an intercurrent respiratory infection.

[Tracheal stenosis and autoimmune thyroiditis]. / Trakeal stenose og autoimmun tyreoiditt.

After exposure to ammonia, a 63 year old woman experienced dyspnoea and respiratory infections. A stenosis was diagnosed in the proximal part of the trachea. High levels of antibodies against thyroperoxidase suggested thyroiditis. After treatment with corticosteroids both the antibodies and the stenosis decreased and the patient's symptoms improved. A few months later the patient developed therapy-resistant uveitis. Cyclosporin was added to the treatment and the condition was stabilized. The diagnosis was unclear. Tracheal stenosis may have developed secondary to autoimmune thyroiditis, while the uveitis probably was another organ manifestation of the autoimmune disease. The ammonia may have caused mucosal oedema, increasing the obstruction to symptomatic level.

Human bronchial perfusion evaluated with endoscopic laser Doppler flowmetry.

Endoscopic laser Doppler flowmetry (LDF) was used to study human bronchial microvascular perfusion in 25 healthy subjects. In total 617 recordings with good signal to noise ratio were obtained and, in the hands of an experienced bronchoscopist, the procedure did not cause major technical problems. Curve fluctuations synchronous to heart rate and respiration were identified. The spatial variation of measurements in one region was considerable, but when the mean of four measurements was used, acceptable precision levels were obtained. Regional differences were observed between 40.3 arbitrary perfusion units (PU) (34.0-46.6) in the right upper lobe bronchus and 77.3 PU (63.6-91.0) at the main carina. Measurements were obtained from the main carina, the right upper lobe bronchus, the apical segment of the right and left lower lobe bronchus. In all bronchi, recordings were performed at two locations distal to the bifurcation; 1-5 mm (central) and 6-10 mm (peripheral). The peripheral flux levels were significantly higher than the central (p < 0.001). Analysis of the short and long term temporal variation showed no significant differences, when the data was analyzed on a group basis. We conclude that LDF seems to be a promising method for future clinical investigations.

[Invasive or transcutaneous measurements of oxygen saturation and blood gases? An evaluation of pulse oximetry and transcutaneous measurement of PO2 and PCO2 during rest and exercise]. / Invasive eller transkutane målinger av oksygenmetning og blodgasser? En evaluering av pulsoksymetri og transkutan måling av PO2 og PCO2 i hvile og under belastning.

Arterial and transcutaneous measurements of the oxygen saturation (SO2), the partial pressure of oxygen (PO2) and the partial pressure of carbon dioxide (PCO2 were compared during rest before and after cycling, and during submaximal and maximal exercise, in 12 adult patients with cystic fibrosis. SO2 was measured non-invasively using two different pulse oximeters (Radiometer and Ohmeda, respectively) and PO2 and PCO2 were registered with a transcutaneous electrode (Radiometer). The coefficients of correlation between arterial and transcutaneous values were respectively 0.95 (Radiometer) and 0.85 (Ohmeda) for SO2, 0.77 for PO2, and 0.75 for PCO2. On average the differences between arterial and transcutaneous values were small, but varied by 3-4% (2SD) for SO2, 2.0 kPa for PO2 and 1.0 kPa for PCO2. Our results indicate that pulse oximetry is a reasonably good way of detecting severe arterial hypoxemia during work, whereas the transcutaneous measurements of PO2 and PCO2 show such large variations that this method cannot be recommended for clinical use.

[Embolization of bronchial arteries in severe and recurrent hemoptysis]. / Embolisering av bronkialarterier ved alvorlige og residiverende hemoptyser.

Bronchial artery embolization is an established treatment for massive and serious haemoptysis. We review etiology, pathogenesis and different treatment modalities of major haemoptysis, and discuss indications and outcome. Massive haemoptysis, defined as > 300 ml/24 hrs., is a rare condition with a high mortality rate (30-80%) if treated conservatively. We describe seven patients treated with bronchial artery embolization. Three patients had massive haemoptysis, and four patients were treated for recurrent and severe haemoptysis. Two patients had haemorrhage because of inactive tuberculosis, five had cystic fibrosis. All patients were successfully treated by embolization, one patient suffered recurrent haemoptysis after four weeks. The other patients have shown no further haemoptysis during the observation period (mean 20 months). No complications were observed other than the common, self-limited post-embolization syndrome (mild fever and chest pain). In patients with severely reduced lung function and progressive disease, recurrent haemoptysis of even smaller amounts might interfere with postural drainage and cause infections and deteriorate lung function. Bronchial artery embolization should be considered for these patients as well. Unless localized lesions can be cured through surgical resection, we consider bronchial artery embolization to be the treatment of choice.

Eight-year follow-up of pulmonary function and oxygen uptake during exercise in 16-year-old males with cystic fibrosis.

Eight of nine Norwegian 16-year-old males with cystic fibrosis, and six age-matched, physically active controls were included in an eight-year follow-up study, involving pulmonary and bicycle exercise testing. The individual's level of regular physical exercise was registered, and we investigated whether or not this could be correlated to changes in clinical status, lung function and maximal oxygen uptake. Four males with cystic fibrosis trained regularly for 4-7 h weekly, while the other four patients did no regular exercise. Three of the latter died during the study, and the fourth male in the non-training group deteriorated significantly during the study period of eight years. The four males in the training group showed improvement in lung function parameters and maximal oxygen uptake, but two of them had more marked obstructive lung disease after the age of 24 years. Even though the sample was small, and several other factors may influence the results, the study indicates that regular physical exercise has beneficial long-term effects on clinical status, lung function and physical fitness in adolescent cystic fibrosis males.

[Lung physiotherapy in cystic fibrosis]. / Lungefysioterapi ved cystisk fibrose.

This article is intended as a brief practical guide for physicians and physiotherapists concerned with the treatment of cystic fibrosis. Physiotherapeutic techniques for the treatment of chest diseases have been developed and modified as advances have taken place in the medical management of cystic fibrosis. The article describes forced expiratory technique, positive expiratory pressure, postural drainage, autogenic drainage and other techniques. Patients with cystic fibrosis live longer and have a better quality of life than ever before, but progressive deterioration of lung function will always be their most serious problem. Physical activity and chest physiotherapy are essential parts of all treatment regimens for cystic fibrosis. It is important to realize that the physiotherapist is a very important member of the team which includes nurses, physicians-and the patient.

Tuberculosis emerging in patients treated with corticosteroids.

Corticosteroid therapy is held to facilitate activity of tuberculous disease. This retrospective study is an analysis of 1355 patients suffering from tuberculosis who had been discharged from a chest hospital during a 9-year period starting in 1971. Those on corticosteroid therapy for the last 6 months prior to diagnosis, were included. There were no new cases of tuberculosis among these, but 40 patients or 3 per cent had reactivation of former disease. The findings should be representative of the national prevalence. Despite increasing use of corticosteroids, there is no indication that the number of reactivated cases associated with such treatment has increased during the years. A majority of our patients were suffering from serious corticosteroid-demanding diseases which might in themselves be as causative as the drug therapy in activating the tuberculosis.