Cases Of Bronchiectasis Research Articles

Bronchiectasis in a patient with CREST syndrome

Bronchiectasis is an uncommon pulmonary manifestation of systemic sclerosis (SSc). We report the case of a 70-year-old woman with CREST syndrome and vasculitis who developed multifocal symptomatic bronchiectasis. The bronchiectasis and immunosuppressive therapy precipitated severe lower respiratory tract infection, which was fatal within a few months. The concomitant occurrence of bronchiectasis and SSc raises the possibility of a pathophysiological relationship. Several hypotheses can be put forward to explain the occurrence of bronchial wall damage leading to bronchiectasis. Whatever the mechanism, cases of bronchiectasis in patients with SSc should be reported to make physicians aware of the substantial risk associated with this combination.

Bronquiectasias associadas à síndrome de Sjögren

Diversas formas de comprometimento pulmonar têm sido descritas na síndrome de Sjögren, incluindo raros casos em que bronquiectasias foram o achado predominante. Relata-se o caso de uma paciente com história de infecções respiratórias de repetição e dispnéia progressiva de longa evolução, cuja tomografia computadorizada de alta resolução evidenciava inúmeras bronquiectasias. A revisão de uma biópsia pulmonar realizada no início dos sintomas mostrava alterações bronquiolares de natureza inflamatória e fibrótica. Apesar da presença de sintomas de síndrome seca há anos, o diagnóstico de SS foi feito apenas tardiamente. São discutidos os possíveis mecanismos patogenéticos que possam ter levado ao desenvolvimento das bronquiectasias e a necessidade de um apurado senso clínico para o diagnóstico precoce de tais condições.

Neutrophil Inflammation and Activation in Bronchiectasis: Comparison with Pneumonia and Idiopathic Pulmonary Fibrosis

Background: Pulmonary inflammation in bronchiectasis, pneumonia and idiopathic pulmonary fibrosis (IPF) is dominated by neutrophils. Pathophysiologic differences are seen in the degree of airway and tissue destruction. Neutrophil activation and neutrophil proteolytic activity might differ between bronchiectasis, pneumonia and IPF. Objective: The aim of this study was to determine whether levels of inflammatory and protective markers in bronchoalveolar lavage (BAL) differed among cases of bronchiectasis, pneumonia and IPF. Methods: We studied 11 bronchiectasis patients (group 1), 30 pneumonia patients (group 2), 15 IPF patients (group 3) and 12 healthy volunteers (group 4). In the bronchoalveolar lavage fluid, concentrations of α₁-proteinase inhibitor, myeloperoxidase (MPO) and elastase-α₁PI complex were determined using immunoluminometric assays. Elastase inhibition capacity (EIC) and elastase activity were determined using a colorimetric assay. Results: No EIC, but free elastase activity, was found in 82% of group 1, 20% of group 2, 20% of group 3 and 0% of group 4. Median MPO concentration was highest in group 1: 7,951 ng/ml (16th–84th percentile [16–84%]: 256–36,342) vs. 692 ng/ml (106–2,279; group 2), 332 ng/ml (98–1,657; group 3), and 0.12 ng/ml (0.08–0.26; group 4). Bronchiectasis patients with bronchial Pseudomonas infection showed higher amounts of neutrophils (p < 0.01) and higher elastase activity (p < 0.05) than patients with sterile lavage. Conclusion: Bronchiectasis patients show a severe imbalance between neutrophil activity and protective molecules leading to possible lung destruction. Chronic Pseudomonas infection might trigger neutrophil activation. Future research and treatment strategies should focus on increased bacterial clearance and inhibition of neutrophil toxicity.

Endoscopic Surgery. Video-assisted Thoracic Surgery (VATS) for Lung Cancer.

From September 1992 to April 1999, 165 video-assisted thoracic surgery (VATS) lobectomies were performed at Saiseikai Kanagawa-ken Hospital. The lesions consisted of 130 cases of lung cancer, 12 cases of bronchiectasis, 8 cases of granuloma, 5 cases of metastatic tumors, and 10 cases with other miscellaneous diseases. Among the 130 cases with lung cancer, 94, who were diagnosed as stage I clinically, underwent a VATS lobectomy with extended lymph node dissection. The 5-year survival rate of these final stage I lung cancers following VATS was 96.6%. This survival rate is significantly better than that for open thoracotomy (78.5%: p<0.001). We conclude that VATS lobectomy with extended lymph node dissection can become a new standard procedure for clinical stage I lung cancer to replace open thoracotomy.

Bronchiectasis in childhood in the state of qatar

Abstract We reviewed 35 cases of bronchiectasis seen at the Department of Pediatrics of Hamad Medical Corporation in the State of Qatar. The main objective was to determine the etiology and the clinical features and to evaluate their management Ages ranged from 7 months to 12 years with a mean of 63.8 months. The male to female ratio was 1.7:1 and 23 (65.9%) of the cases were diagnosed before the age of six years. Cough was present in every case and rales in 30 (85.7%) of the cases. Dyspnea, wheezing, clubbing and failure to thrive were found less frequently. The cause of the bronchiectasis was unidentifiable in almost 50% of the cases and in the remainder it was due to childhood infection (2 cases), congenital and genetic disorders (6 cases, including 4 cases of cystic fibrosis, 1 case of ciliary dyskinesia and 1 case with congenital right middle lobe bronchus stenosis), immune defects (4 cases), airway obstruction (4 cases, including two cases of foreign body aspiration), extrinsic compression (1 case), bronchial asthma with right middle lobe syndrome (1 case) and four miscellaneous cases: Down's syndrome with A-Vcanal (1 case), persistent RLL atelectasis (2 cases), and mediastinal lymphadenopathy with persistent LLL atelectasis (1 case). Of the various diagnostic methods available, CT was found to be the most conclusive and surpasses the other diagnostic modifies of bronchiectasis in children and should then be resorted to any clinical suspicion of the disease. The outcome of medical treatment, (excluding 4 cases of cystic fibrosis) was that 7 cases missedfollow-up, 7 cases responded favorably, 4 cases remained unchanged, 2 cases died (one with HIV and one with Down's syndrome and congenital heart disease) and 11 cases were referred for surgery. Both medical and surgical treatments are discussed and the recommendations for surgery outlined. Address for correspond

Video-assisted thoracic surgery (VATS) lobectomy: the Japanese experience.

Between September 1992 and October 1997, we performed 128 video-assisted thoracic surgery (VATS) lobectomies. The indications for surgery were 103 cases of lung cancer, 11 cases of bronchiectasis, 8 cases of granuloma, 4 cases of benign lesions, and 2 cases of metastatic tumors. Of the 103 cases of lung cancer, 62 were treated by VATS lobectomy with extended lymph node dissection for clinical stage I lung cancer, and the 4-year survival rate of final stage I lung cancer was 94.4%. VATS lobectomy is far less invasive than open thoracotomy, and survival rates after VATS lobectomy with extended lymph node dissection are comparable with those after open thoracotomy. Thus, VATS lobectomy with extended lymph node dissection should be considered as a standard surgical alternative to open thoracotomy for stage I lung cancer.

Persistent and chronic lung disease in HIV-1 infected and uninfected African children.

The causes of persistent lung disease (PLD) and chronic lung disease (CLD) are unknown in HIV-infected children in developing countries. We describe the causes and course of PLD and CLD in HIV-infected and uninfected children. Of 194 children with lung disease persisting for at least 1 month who were seen at the paediatric respiratory clinic over a 2-year period, 42 underwent invasive investigations after failed initial management over 3 months. PLD was defined as the presence of clinical and radiological features of lung disease for more than 1 month, and CLD as these features for more than 3 months. One hundred and thirty-eight (71%) of the 194 children with PLD were HIV-infected, 52 (27%) were not infected and four (2%) were of undetermined HIV status. Forty-eight per cent of the HIV-infected children and 52% of the HIV-uninfected children responded to initial treatment over 3 months; the presumptive diagnoses in these were tuberculosis, interstitial pneumonitis, bronchiectasis and post-ventilation lung syndrome. Of the 28 HIV-infected children with CLD who underwent invasive investigations 16 (57%) had lymphoid interstitial pneumonitis, eight (29%) had tuberculosis and four (14%) had non-specific interstitial pneumonitis. Of the 14 HIV-uninfected children with CLD who had invasive testing there were four cases (29%) each of tuberculosis and interstitial pneumonitis, three (22%) cases of bronchiectasis and one case of each of extrinsic allergic alveolitis, crytogenic fibrosing alveolitis and non-Hodgkin's lymphoma. This is the first set of data on the causes of CLD in HIV-infected children in a developing country. Every effort should be made to identify the infectious agent, whether M. tuberculosis or a secondary bacterial infection in LIP, in order to treat most appropriately these children with lung disease.

Lobectomy with extended lymph node dissection by video-assisted thoracic surgery for lung cancer.

Between September 1992 and September 1996, we performed 88 VATS (video-assisted thoracic surgery) lobectomies and two VATS pneumonectomies. The indications for surgery were 68 cases of lung cancer, nine cases of bronchiectasis, six cases of tuberculosis, and seven cases of benign lesions. Of the 68 cases of lung cancer, 36 were treated by VATS lobectomy with extended lymph node dissection for clinical stage I lung cancer, making full use of recently developed devices for thoracoscopic surgery, such as roticulating endoscissors, miniretractors, endoclips, and harmonic scalpels. Twenty-four lymph nodes were resected on average (range, 10 to 51) by VATS. This number was comparable to lymph nodes resected in open thoracotomy during the same period. Among the 36 patients who underwent extended lymph node dissection, 20 showed no lymph node metastasis postoperatively (stage I), while 16 had N1 or N2 cancer. All patients with stage I cancer have survived 4 to 36 months (median: 17 months) with no signs of recurrence. This survival of stage I lung cancer after VATS is comparable to that of open thoracotomy. We thus believe that VATS lobectomy with extended lymph node dissection can be an alternative to standard posterolateral thoracotomy for stage I lung cancer.

Elevated levels of cytokeratin 19 in the bronchoalveolar lavage fluid of patients with chronic airway inflammatory diseases--a specific marker for bronchial epithelial injury.

Cytokeratin 19 (CK19) is a specific cytoskeletal structure of simple epithelia, including bronchial epithelial cells (BEC). Since CK19 is released from injured bronchial epithelium, we investigated the levels of CK19 fragments in the bronchoalveolar lavage fluid (BALF) of eight patients with chronic airway inflammatory diseases (CAID) using an enzyme-linked immunosorbent assay (ELISA). Included in our test group were four cases of chronic bronchitis, three cases of bronchiectasis, and one case of diffuse panbronchiolitis. There were also 15 control subjects (five asymptomatic smokers and 10 nonsmokers). BALF from the nonsmokers as well as from the asymptomatic smokers contained few CK19 fragments (0.2 +/- 0.2 and 1.9 +/- 0.8 pg/ml, respectively). In contrast, significantly high levels of CK19 were present in the BALF of patients with CAID (21.7 +/- 5.7 pg/ml; p < 0.01 versus nonsmoking controls). In addition, CK19 fragment concentrations in BALF correlated significantly with the number of neutrophils (r = 0.722, p < 0.01) but not with the numbers of macrophages or lymphocytes in BALF. BALF from patients with CAID contained high levels of neutrophil elastase (NE) activity, suggesting that NE might be an important stimulus for the release of CK19 from BEC. To prove this, we incubated BET-1A cells, a human immortalized bronchial epithelial cell line, both in the absence and the presence of inflammatory mediators (including NE, tumor necrosis factor-alpha [TNF-alpha], and hydrogen peroxide). We then measured the concentration of CK19 fragments in the culture supernatants with ELISA. BET-1A cells released CK19 fragments into their culture supernatants after treatment with NE but not after treatment with TNF or hydrogen peroxide. Further, we demonstrated that CK19 cleaved by NE could not be detected by ELISA. Our results suggest that CK19 measurement in BALF is useful for assessing the presence of bronchial epithelial injuries.

Increased incidence of cystic fibrosis gene mutations in adults with disseminated bronchiectasis.

In order to identify a possible hereditary predisposition to the development of obstructive pulmonary disease of unknown origin, we have looked for the presence of Cystic Fibrosis Transmembrane Regulator (CFTR) gene mutations in unrelated patients with no signs of Cystic Fibrosis (CF). We screened for 70 common mutations, and also for rare mutations by denaturing gradient gel electrophoresis analysis. In this search, different CFTR gene mutations (R75Q, delta F508, R1066C, M1137V and 3667ins4) were found in five out of 16 adult Italian patients with disseminated bronchiectasis, a significant increase over the expected frequency of carriers. Moreover, three rare CFTR gene DNA polymorphisms (G576A, R668C, and 2736 A-->G), not deemed to be the cause of CF, were found in two patients, one of which was a compound heterozygote with R1066C. These results indicate that CFTR gene mutations, and perhaps also DNA polymorphisms, may be involved in the etiopathogenesis of at least some cases of bronchiectasis.

Presence, activities, and molecular forms of cathepsin G, elastase, alpha 1-antitrypsin, and alpha 1-antichymotrypsin in bronchiectasis.

The presence, activities, and molecular forms of the serine proteinases, elastase, and cathepsin G, and their endogenous inhibitors, alpha 1-antitrypsin and alpha 1-antichymotrypsin, were investigated in bronchoalveolar lavage (BAL) fluid of bronchiectasis patients divided into mild, moderate, and severe disease subgroups and compared to BAL fluid from healthy controls. Immunochemical characterization and quantitation were performed by Western immunoblot. The activities of elastase and cathepsin G were recorded spectrophotometrically using synthetic substrates. The results showed a significant difference in elastase and cathepsin G activities in BAL fluid of the three subgroups, revealing the following data--mild subgroup, 0.21 +/- 0.09 mU/g and 57.35 +/- 20.9 U/g; moderate subgroup, 1.87 +/- 1.12 mU/g and 89.24 +/- 31.4 U/g; and severe subgroup, 2.64 +/- 1.63 mU/g and 139.18 +/- 58.3 U/g, respectively--compared to those of the healthy control group, 0.09 +/- 0.03 mU/g and 50.96 +/- 16.5 U/g. Evidently, the protective shield of plasma-derived antiproteinases was sufficient in healthy subjects and, also, in mild cases of bronchiectasis, but not in cases of severe and moderate forms of bronchiectasis, in which free and catalytically active elastase and cathepsin G were detected. The serine proteinases inhibitors (serpins), alpha 1-antitrypsin and alpha 1-antichymotrypsin, have evidently been oxidized and/or proteolytically cleaved in the cases of moderate and severe bronchiectasis. The results indicate that insufficient endogenous downregulation of catalytically active elastase and cathepsin G in BALF leads to tissue injury, resulting in alterative and deformative processes in the bronchiectasis lung.

Bronchiectasis with concomitant lung cancer. A report of 7 cases : Chen Y. Department of Thoracic Surgery, Fourth Affiliated Hospital, Hebei Medical College, Shijiazhwang 050011. Chin J Oncol 1993;15:461–463

This article reports 7 cases of bronchiectasis with concomitant lung cancer, accounted for 3.6% of 194 cases of bronchiectasis admitted in the same period. The carcinoma originated from the pulmonary tissue with bronchiectasis in 5 cases, and from the superior segment of lower lobe with bronchiectasis in the basal segment in the other two cases. In 5 cases (71.4%) the tumor was smaller than 3 cm in diameter or only invaded into the submucosa, representing an early stage cancer. On the plain films of the chest only one case revealed a mass suspecting of the presence of carcinoma. Obviously it was hard to make a correct diagnosis in such a situation. In our group, correct preoperative diagnosis was made only in two cases and suspected of concomitant cancer in 3, while in the other two cases a definite diagnosis was obtained postoperatively by histopathological examination. In one of those two cases the lesion was so small that the diagnosis was made after several consecutive pathological examinations. It is emphasized that cytological examination of sputum and bronchoscopy should be performed in every patient. A CT scanning of the chest is of great help to find very small foci. Any massive lesions revealed on the film or CT scanning should be considered as a lung cancer. During operation pulmonary nodules should be also considered as possible cancers. The surgical specimen should be examined thoroughly to avoid missing of any minute cancer foci.

Late morphologic consequences of measles: a lethal and debilitating lung disease among the poor.

Pneumonia that occurs within 28 days of the onset of measles rash is a common cause of severe pulmonary morbidity and/or death among poor children. The prevalence of such pneumonia can be related to the effectiveness of measles immunization programs. For 20 of 57 new cases of bronchiectasis in children undergoing bronchography, a strong causal relationship to measles was found. The lungs of 21 unselected children who died in the wake of measles were examined. Severe necrosis of bronchi and bronchioles was found in those children who had developed intercurrent adenovirus and herpesvirus infections. Bacterial suppuration produced a less severe necrosis. It is suggested that intercurrent adenovirus and herpesvirus infections that occur following measles are the most important initiating causes of follicular bronchiectasis in childhood. The severity of these supervening infections may be mediated by the transient immune suppression that occurs as a consequence of both measles and inadequate nutrition.

Bronchoscopy in chronic obstructive lung diseases in children

Bronchoscopy has helped to clear obstruction in all cases of foreign bodies. Immediate improvement resulted in 60% cases of bronchiectasis, 62% cases of progressive primary complex, and 40% cases of collapse of the lung. Evidence of endobronchial tuberculosis such as inflammation, caseation, ulceration and granulation were found in 36% of cases of primary complex. In none of the cases was there any exacerbation of the disease process. Complications occurred in children with poor general condition.

Bronchiectasis in childhood.

In a study of 30 cases of bronchiectasis in childhood, the following observations were made: 46.7% of the cases were in the age range of five to eight years and 36.6% in the age range of nine to twelve years. Male: female ratio was found to be 2.8:1. Predisposing factors were not found in 50 per cent of the cases. Foreign body aspiration as the cause of bronchiectasis was not seen at all. Cough with expectoration was the commonest symptom followed by haemoptysis. Clubbing was found in 56.7% of the cases. Unilateral bronchiectasis was mofe common than bilateral. Lingular involvement alone was not demonstrated. The posterior basal segment of the left lowe lobe was the segment affected most often Saccular bronchiectasis was the commones morphological variety followed by mixed and tubular bronchiectasis. We do not believe that such structural subdivisions serve any useful purpose. There was no evidence that various morphological types have different aetiopathogenesis and prognosis.

Clinical effects of lividomycin on respiratory tract infections, primarily wet cases of bronchiectasis (author's transl)

Patients with various respiratory infections, primarily wet cases of bronchiectasis, were treated with lividomycin (LVDM) at a dose of 1 g/day for about a week. The results obtained are as follows: 1. Of the 15 patients with refractory bronchiectasis who had previously been treated with various other antibiotics, 11 patients (73.3%) responded to LVDM. Although there was no patient who responded to LVDM excellently, good cures were achieved in 5 pateints and fair cures in 6 patients. 2. In bronchiectasis patients having infections in association with pulmonary tuberculosis (mixed infections), LVDM did not show any remarkable effects, excepting that fair cures were achieved in 3 patients. 3. In the 7 patients with acute bronchopneumonia, excellent, good and fair cures were achieved in 1, 5 and 1 patient, respectively. Although LVDM was effective in all of the patients with the said infection, the number of the patients responded excellently was meager and the onset of action seemed to be somewhat slow. 4. In one patient with lobar pneumonia, LVDM was not effective. 5. The MIC values of LVDM for clinically isolated various organisms are summarized below: Pseudomonas aeruginosa 50 mcg/ml, Klebsiella pneumoniae 3.13 to 6.25 mcg/ml, Haemophilis influenzae 1.56 to 6.25 mcg/ml, Diplococcus pneumoniae 50 mcg/ml, alpha-Streptococcus 50 to 100 mcg/ml, beta-Streptococcus 100 mcg/ml, and Staphylococcus aureus 1.56 mcg/ml. 6. In spite of the fact that a majority of the patients participated in this study were the aged, LVDM's side effects were limited to an increase of BUN (one patient) and eruption (one patient). Any noticeable changes in hepatic and renal function, hearing acuity, etc. were not observed. As indicated above, LVDM was effective against, respiratory infections as well as infections of the urinary tract on which a considerable number of research has already been reported. Thus, it is considered to be worthwhile to use LVDM for the treatment of respiratory infections.

Situs Inversus Totalis and Kartagener's Syndrome in a Japanese Population

Eight cases of situs inversus totalis were detected in the Atomic Bomb Casualty Commission-Japanese National Institute of Health (ABCC-JNIH) Adult Health Study sample of Hiroshima and Nagasaki, Japan. The prevalence of situs inversus totalis was one per 4,100 population. This rate is about two times that reported among Caucasians. The prevalence of bronchiectasis, which is frequently noted as an associated abnormality or complication of situs inversus, showed a significant increase when compared with that of subjects in general. Study of our cases of bronchiectasis and review of literature, although not conclusive, seemed to indicate that a congenital factor was involved. Previously reported normal peripheral blood chromosome studies were confirmed.

Treatment of bronchiectasis with intratracheal antibiotics instillation and the significance of bacteriological tests of the sputum from the trachea

Intratracheal instillation therapy with antibiotics was given to 43 cases of bronchiectasis. Of them, 21 cases were markedly and 22 cases were moderately improved. Intratracheal instillation was done by intercartilagenous puncture once every or every other day. This method is simple, easy and safe in repeating. Tracheal sputa are completely free from contamination from oral and pharyngeal cavity. The patterns of intratracheal bacterial flora were constant and stable in each individual case through the course of treatment.In 43 cases of bronchiectasis tracheal sputa were examined aerobically. In 9 cases no aerobic bacteria were cultured and 66.7% of them were markedly improved. In 12 cases Streptococci and/or Staphylococci were cultured and 50.0% were markedly improved. In 13 cases Coli-Paracolon group with or without Streptococci and/or Staphylococci were cultured and 61.5% were markedly improve. In 9 cases Pseudomonas with or without Streptococci and/or Staphylococci and/or Coli-Paracolon group were cultured and 11.1% were markedly improved.In 34 cases with positive aerobic culture, Streptococci were obtained in 21 cases and Coli-Paracolon group in 15 cases, Staphylococci in 11 cases and Pseudomonas in 9 cases.In 15 cases of bronchiectasis tracheal sputa and expectorated sputa were cultured on chocolate agar plates. In tracheal sputa of 2 cases Hemophilus were cultured, whereas, in expectrated sputa of 5 cases Hemophilus were cultured.Considering these bacteriological patterns, antibiotics were selected: Penicillin to negative culture cases and cocci infection cases; Therramycin or Kanamycin to bacilli infection cases; Penicillin, Terramycin or Kanamycin, alone or alterately, to mixed infection cases.Thirty one cases of bronchiectasis were divided into three groups according to the extent of the lesions, 12 cases of (+) group, 9 cases of group and 10 cases of group. Gram-negative bacilli were found in 42.8% of (+) groups, whereas, 60.0% of group. Thirty one cases of bronchiectasis were grouped into three groups according to duration before the chemotherapy, 12 cases of less than 5 years duration, 9 cases of less than 10 years and 10 cases of more than 10 years. Gramnegative bacilli were found in 47.6% of less than 5 and 10 years group, whereas, in 70.0% of more than 10 years group.The infection of Gram-negative bacilli, the longer duration of the disease before this therapy and the greater extent of the lesions are, relating each other, the main causes of lowering the cure rate of bronchiectasis.

Pasteurella septica infection in respiratory disease.

Bacteria ofthegenusPasteurella arewellrecognizedintheveterinary worldas thecause of various diseases of domestic, farm,and wild animals, suchas fowlcholeraand epidemic haemorrhagic septicaemia of swineand cattle. Since theearliest reports ofhumaninfection from Europe, Schipper (1947) collected 21 cases recorded between 1919and1946:eight ofthese had infected bites, andsevenhadpulmonary infection. Ofthe37casesreviewed byOlsenandNeedham (1952) andseenattheMayoClinic, 35haddisease oftheupper andlowerrespiratory tract, and bronchiectasis was confirmed bybronchography in30.Pasteurella septica was recovered from bronchial aspirates butrarely fromsputum,and itwas considered thattheorganism was a secondaryinvader inpre-established bronchiectasis. In theUnitedKingdom,CawsonandTalbot(1955) reported two cases ofbronchiectasis infarmers secondarily infected withP.septica andsuggested catsanddogsas thecommonestsource-an observation supported by Smith(1955), who isolated itfromtonsillar swabsin54% of 111 Londondogs.Further case reportsby Bartley (1960), DeBoerandDumler(1963), Freigang and Elliott (1963), BrodieandHenderson (1963), and ManecheandToll(1964) confirm thatP.septica may appearinthesputumcultures ofpatients with chronic infection oftherespiratory tractfollowinganimal contact. Because itisan unusual finding, andinviewof therecentinterest showninzoonoses generally, eight casesencountered inGloucestershire during a four-year period arereported; insome ofthem theinfection may haveplayed an important part inthecurrentacuterespiratory illness.

Study of the effects of Valsalva's maneuver on the electrocardiogram and its clinical significance in patients with chronic respiratory diseases

There have been already many investigations on the circulatory effects of Valsalva maneuver, and especially with regard to the change of pulmonary circulation it has been made clear that the venous return to right heart during straining is blocked by the increased intrathoracic pressure, and then by the sudden fall of the intrathoracic pressure after release of straining the blood remaining stagnant in the face and extremities suddenly flows into the right heart and the stroke volume of the right ventricle increases compared with that at rest and there is a transient rise of the pulmonary arterial pressure and the net pulmonary capillary pressure. The purpose of this report is to present the electrocardiographic changes by the Valsalva maneuver in patients of chronic broncho-pulmonary diseases in an attempt to detect any specific electrocardiographic changes in pulmonary hypertension or latent cor pulmonale and to discuss their clinical significance. Materials and Methods: (1) One hundred and eleven cases have been chosen for this study, including 76 cases of chronic respiratory diseases, 15 cases of non-cardiopulmonary diseases, 5 cases of neurocirculatory asthenia and 15 cases of healthy adults. The 76 cases of respiratory diseases consists of 35 cases of pulmonary tuberculosis (including 12 cases of after operation and 6 cases of severe pleural involvement), 10 cases of pulmonary emphysema, 8 cases of bronchiectasis, 20 cases of chronic bronchitis and bronchial asthma and 3 cases of lung tumor. (2) First the routine electrocardiogram at rest was recorded, and then, during and following the Valsalva maneuver at lead I, II, III, V1 and V5. The Valsalva maneuver was performed by having each subject maintained an expiratory pressure of at least 40mm.Hg for about 10 seconds by blowing into a aneroid sphygmomanometer. Next, of 20 cases including 10 cases taken at random out of the patients of severe broncho-pulmonary diseases and another 10 cases of healthy adults and in-patients without cardiopulmonary diseases, the author recorded their electrocardiogram at rest and following Valsalva maneuver at a speed of 50mm per second, photographically enlarged it, and observed the changes in the ventricular activation time and QRS amplitude at V1, studying the measured values of both groups in comparison. The respiratory function was judged from the ventilatory function measured with a 9.0 L or 13.5 L Bendict-Roth type respirometer.