1/6. Diffuse panbronchiolitis: a treatable sinobronchial disease in need of recognition in the united states.Diffuse panbronchiolitis (DPB) is a progressive inflammatory disease, well recognized in japan, characterized by sinusitis and obstructive small airway disease; if left untreated, it progresses to bronchiectasis, respiratory failure, and death. Treatment using low-dose erythromycin has proven to be highly efficacious. Lack of familiarity with DPB in the united states may result in the failure to correctly diagnose and treat this disorder. We describe a Cambodian man in whom the characteristic imaging and histologic features of DPB were elicited but not recognized in spite of evaluation at a referral center. When DPB was diagnosed 6 years later, he was in respiratory failure, but made an excellent recovery once erythromycin therapy was instituted. We report this case to increase physician awareness of DPB as a cause of sinobronchial disease and discuss its diagnostic features so that the disease is recognized and treated without delay.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Diffuse panbronchiolitis: an underdiagnosed disease? Study of 4 cases in brazil.BACKGROUND: Diffuse panbronchiolitis is a clinical pathologic condition characterized by chronic inflammation of respiratory bronchioles, with clinical features that position it as a differential diagnosis among the sinopulmonary syndromes. methods AND RESULTS: We present 4 cases (1 Black, 2 Japanese descendants, and 1 Japanese), living in brazil, in which the diagnosis was made by the clinical and radiological features and confirmed by transbronchial biopsy. The clinical findings included chronic sinusitis, productive cough, rhonchi, and wheezes. The pulmonary function tests showed an obstructive pattern. High resolution computerized tomography showed a diffuse nodular pattern, airway ectasia, and airway wall thickening. The biopsy showed interstitial accumulation of foam cells and lymphoid cells in the walls of respiratory bronchioles: 2 of our cases had bronchus-associated lymphoid tissue hyperplasia. We searched for the HLA Bw54 in all of our patients, but only 1 was positive. A low dose macrolide treatment was introduced, resulting in with clinical and functional improvement. A score that rated the extent of nodules, airway ectasia, mucus plugging, and airway wall thickening was applied on pre- and post-treatment High resolution computerized tomography results, revealing an improvement in tomographic pattern related to that observed in the pulmonary function tests. CONCLUSION: We conclude that diffuse panbronchiolitis is a systemic disease that is not exclusive to the Asian population, whose clinical and radiological features should be better known by occidental pulmonary physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Anomalous left coronary artery masquerading as infantile bronchiolitis.Four infants less than six months of age with anomalous left coronary artery from the pulmonary artery who present with symptoms of wheezing are described. All had cardiomegaly on chest radiographs and because of wheezing received beta-agonist agents (albuterol alone or with epinephrine). One developed cardiopulmonary collapse secondary to supraventricular tachycardia after administration of these agents. The literature is reviewed for utility of chest radiographs in infants presenting with wheezing and for the efficacy of beta-adrenergic agents in infants less than six months of age. The authors suggest that physicians have a low threshold for obtaining a chest radiograph prior to treating a first-time wheezing infant less than six months of age with a beta-agonist agent.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Neurologic complications associated with respiratory syncytial virus.Encephalopathy has been demonstrated to be associated with respiratory syncytial virus bronchiolitis. In this study, the data on all patients less than 14 years of age hospitalized with respiratory syncytial virus bronchiolitis over the past 4 years was reviewed. patients who had concomitant diagnoses consistent with neurologic disease underwent detailed chart review. There were 964 patients (age 0.1 to 13.6 years) with a diagnosis of respiratory syncytial virus bronchiolitis. Thirty-six of these patients had concurrent neurologic diagnoses. Twenty-four patients were excluded because of preexistent neurologic disorders, probable simple febrile seizures, or a history of epilepsy. Twelve respiratory syncytial virus-positive patients had definite neurologic complications without another recognized cause. Seven of these patients had seizures (predominantly generalized tonic-clonic and one with status epilepticus), three had generalized encephalopathy (marked hypotonia and decreased responsiveness) of whom two also developed esotropia. Two patients developed isolated esotropia. There was an incidence of neurologic complications of 1.2% (0.7% seizures) in a total of 964 patients with respiratory syncytial virus bronchiolitis. This percentage does not include presumed simple febrile seizures or exacerbations of preexisting seizure disorder (further 1.3%). Neurologic complications occur with respiratory syncytial virus bronchiolitis, and physicians and other caregivers should be aware of this entity as well as the favorable prognosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Childhood diffuse panbronchiolitis: a case report.Diffuse panbronchiolitis (DPB) is a chronic, potentially life-threatening lower respiratory tract disease that is particularly common in Japanese people. If left untreated, it progresses to bronchiectasis, respiratory failure, and death. Lack of familiarity with DPB in the non-far east may result in a failure to correctly diagnose and treat this disorder. We describe a child with DPB. We suggest that DPB is a sinopulmonary disease that is not exclusive to the Asian population and to adults. Its clinical and radiological features should be better known by pediatric pulmonary physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Approach to supraglottitis.In my experience, steroids have no use in the management of ACSOL once the airway is secured, and may actually prolong and complicate the infectious process. The main use of antibiotics is probably for preventing systemic complications such as pneumonia and meningitis. It is possible, however, that neither drug can alter the natural course of this disease and may just hasten its expected inconsequential resolution. The key to successful management of acute supraglottitis is early recognition and prompt provision of airway assistance when indicated. This potentially fatal disease occurs in adults as well as children. To my knowledge, most deaths occur after the patient arrives at the hospital, when there is hesitation and indecision about the need for airway intervention. Whenever signs of UAO appear, artificial airway should be provided promptly, regardless of the eventual diagnosis. Those physicians who try all means to avoid intubation or tracheotomy early in the process may be cautioned that complications from either procedures are just a risk, while airway obstruction in most cases of ACSOL is a certainty. Finally, the examiner assessing patients with possible obstructive laryngitis, supraglottic, or subglottic, should first and foremost decide whether an airway is needed and should defer all diagnostic guesswork and laboratory data processing until the airway is secured.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |