Clinical explanation of Bronchiectasis

Permanent dilatation and distortion of the bronchi is called bronchiectasis. What is it’s effect to human health?

Etiology and Pathogenesis:

Most of the cases of bronchiectasis result from acquired causes.

• Obstruction to the bronchus due to any cause leads to distal collapse of the pulmonary segment. The pull on the bronchi by the collapsed alveoli leads to dilatation of the bronchi. In the initial stages this is reversible and the bronchi regain their normal size when the lung expands. If the obstruction persists, accumulation of mucus occurs distally, infection supervenes and the bronchial wall is destroyed permanently.

This results in permanent dilatation. The infective organisms are streptococci, pneumococci, Klebsiella, and anaerobes.

• Bronchiectasis may follow several viral infections without passing through the obstructive phase.

• Congenital defects in the bronchial wall lead to bronchiectasis. The classical example is Kartagener’s syndrome, which is characterized by dextrocardia, sinusitis, and defects of ciliary function in the bronchi and non-motile sperms.

• Middle lobe bronchiectasis is a sequel to pulmonary tuberculosis. This is caused by obstruction to the middle lobe bronchus by tuberculous glands. This is called “middle lobe syndrome” or “Block’s syndrome”.

Clinical features:

The clinical picture is very chronic, extending over several years.

The common site of lesion is the left lower lobe. Though children may be affected, usually symptoms manifest in early adulthood or middle age. Males are affected more than females. Digital clubbing is a prominent sign, sometimes being associated with hypertrophic pulmonary osteoarthropathy.

Postural cough with the production of large quantities of purulent and foul smelling sputum is the presenting complaint in most cases. On keeping for sometime, the sputum settles into 3 layers as described under lung abscess. Hemoptysis may occur frequently. This may be mild or severe. Recurrent infections such as pneumonia may develop. Repeated affection of the same lobe or segment should suggest the possibility of underlying bronchiectasis. Bronchiectasis sicca is the condition in which bronchiectasis presents with mild or severe hemoptysis without purulent sputum.

Physical examination may reveal impairment of the percussion note and diminution of respiratory sounds over the presence of coarse, persistent leathery rales. At times bronchiectasis may present with one of its complications. These include massive hemoptysis, recurrent pneumonia, emphysema, septicemia brain abscess, and cor pulmonale. Anemia develops in long standing cases due to chronic sepsis and recurrent hemoptysis. In untreated cases secondary amyloidosis may develop.

Diagnosis:

Bronchiectasis should be diagnosed by the long history, presence of clubbing, postural cough, coarse leathery rales over the affected part and reasonably normal general health. Once established, bronchiectasis is not curable by medical treatment.

Differential diagnosis

Bronchiectasis should be distinguished from chronic bronchitis and emphysema, lung abscess, tuberculosis, congenital cystic disease of the lung and malignancy. Lung abscess generally develops acutely. The right lower lobe is affected more often and the signs are localized. Tuberculosis is more common in the upper lobes and clubbing is not prominent in uncomplicated cases. Features like digital clubbing and copious sputum are seen in tuberculous bronchiectasis. Cystic disease is not uncommon. All age groups are affected. A long history or recurrent respiratory disease is present in the majority of cases. Clubbing is not prominent. The cysts may be localized or generalized. Clinical distinction from bronchiectasis is difficult. The presence of cysts in other organs like the kidneys, liver, etc, suggests the probability of congenital cystic disease of the lung. X-ray reveals the presence of soap bubble-like or ring shadows.

Diagnosis is confirmed by bronchography. This procedure is absolutely essential for determining the extent and type of bronchiectasis. Plain X-ray of the chest is not a reliable investigation to assess the site and extent of bronchiectasis.

Management

General measures include high protein diet, treatment of intercurrent infections, and removal of focal sepsis from the upper respiratory tract. Principles of specific therapy include postural drainage, administration of antibodies, respiratory exercises and in selected cases surgical excision. Postural drainage helps in clearing the bronchi and brings about relief. The patient should be instructed to practice postural drainage regularly. This gives relief of cough and also the foul smell. The fetid odor of the breath can be controlled by administering steam inhalations containing tincture benzoin or eucalyptus oil. The choice of antibiotic is determined by microbiological studies. Intermittent antibiotic therapy is required to clear infection and prevent exacerbation. The site of lesion may have to be excised if medical treatment fails.

Indications for surgery:

The following are the indications for surgery.

• The disease is localized to one lung or one segment and is not amenable to medical therapy.
• Socio-economic factors such as non-compliance by the patient
• Uncontrollable hemoptysis in which the site of origin of blood may be detected by emergency bronchoscopy and surgical resection has to be planned;
• To reduce the area of infection-even in bilateral disease sometimes surgical resection may have to be done on the more affected side, with a view to reducing the surface area of infection; and
• To remove an obstructive lesion which tends to perpetuate the condition, eg, bronchial growth or bronchostenosis?

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Medical Equipment Marketplace

The medical equipment marketplace is replete with broad selections of equipment and supplies for medical, dental, and beauty salon equipment. There are several websites devoted to supplying such items. Trade networks exist within social commerce climates that constantly move products in this category every hour of every day. It is a highly competitive market and the information provided regarding the products is sometimes reliable and in other situations it is unreliable.

Within this market it is important to know certain facts. In order to learn these facts, you might have to critically shop around and ask many questions. When you do this, you will find contradictory information as well as useful information. You will see that some businesses selling these products are reliable and others are not. Ultimately it is confusing. One of the best companies that I have seen is Crystal Medical http://www.crystalmedical.co.uk.

Crystal Medical has a special niche in the medical equipment marketplace. They offer an exceptional variety of products in many categories including dental, medical, surgical, opthamalic, nursing, homecare, veterinary, pharmaceutical, and software categories. All of the products they offer are of high quality. Their dental equipment line is comprehensive and takes quality seriously.

Perhaps one of their best features is the flexible payment plans. With Crystal Medical, you may purchase medical equipment, dental equipment, and beauty salon equipment outright or you may rent the products on agreement for nominal fees. They have their payment plans set up in such a way that the equipment you purchase can pay for itself with added profit. Often these upgrades in equipment yield better business profits, easily offsetting the cost of the equipment itself.

Uncategorizedly, there are other organizations that offer similar equipment. You should research those as well. I believe you will discover that Crystal Medical offers the best products and the most practical payment plans. Considering the fact that they offer a 5 year warranty on all of the products they sell, it is a deal worth considering. Advance the technology of your healthcare practice with a reliable company and you will be assured better quality and cost.

Eczema – An Explanation

Eczema (Atopic Dermatitis)

Eczema is a chronic, recurrent skin disease and presents as one of the most common inflammatory skin diseases in childhood. Sufferers experience intractable itching with subsequent skin damage, soreness, sleep loss and the social stigma of visible skin damage. Although the cause is not understood , there appears to be a genetic predisposition as well as a combination of allergic and non-allergic factors that determine the diseases expression.

Eczema or Atopic Dermatitis is known as the itch that rashes. Eczema displays in infants as red skin with oozing cracks and small pustules. Eczema lesions are found on the face, wrists, folds of skin and nappy areas of the buttocks. As the child ages the eczema presents as papules and thickened skin in the joint areas. In adults eczema displays as papules and thickened crusted sores that often weep as a consequence of scratching.

Adult eczema is found in flexures, on the face, neck, legs, feet, back of the hands and the genital areas.

Triggers of Eczema

Some people have a genetic inherited tendency to develop eczema, indicated by eczema occurring in families predisposed to hay fever and/or asthma. A normally harmless substance in the environment will often trigger an outbreak of eczema in people born with this tendency. How eczema is first triggered and how severely substances will affect the skin is uncertain as everyone with this genetic tendency is different and reacts differently.

This makes identifying triggers and controlling symptoms difficult. A process for identifying individual triggers is often by elimination and can be a long and drawn out procedure.
Although people react differently and different substances affect each individual differently there are some common substances that are most prone to triggering an eczema flare-up:

* Dust mite
* Animal dandruff
* Pollens
* Environmental and seasonal changes
* Stress
* Some foods ( egg, cows milk, shell fish, peanuts, wheat, nuts, rice, food additives and some fruits)
* Alcohol and coffee.

Nutrition

Nutrition plays a very large role in the outcome for eczema sufferers. An important reason for eczema occurrence is the western diet which promotes inflammation in the body. A defect in the bodies ability to metabolise Gamma-linolenic acid, (GLA) is thought to play a major role in the onset and development of eczema. GLA is the molecule produced from linoleic acid, the body makes Prostaglandins and Arachodonic acid from it. These two products are used by the body to trigger allergic reactions and the bodies response to injury and attack. When there is too much GLA, the body has excessive inflammatory response. The Western diets have an excessive amount of Linoleic acid (omega 6) to the alpha -linolenic acid (omega 3) of 10:1.so GLA promotes inflammation when the person has a defect in its metabolism or usage. This defect is, I believe, the reason that some people suffer eczema .

It is proposed that an eczema sufferer should supplement their diet with specific nutrients, particularly calcium, iodine, vitamin C and omega 3 fatty acids. Vitamin C @ 50 to 75mg/kg has been found to be beneficial. Flaxseed oil and fish are good sources of omega 3 fatty acids. The inclusion of Vitamins A & B6, Zinc and Selenium, Biotin, Evening Primrose Oil & Lecithin are also proposed. Dosages should be worked out by your Naturopath or “enlightened” Doctor .