### How should the diagnosis of bronchiectasis be determined?

#### Recommendations – Imaging

#### Good practice points

CT imaging protocol 

CT features of bronchiectasis 

General 

### In whom should the diagnosis of bronchiectasis be suspected?

#### Recommendations

https://thorax.bmj.com/content/thoraxjnl/74/Suppl_1/1.full.pdf

British Thoracic Society Guideline for bronchiectasis in adults

Several new international recommendations have been published since the German Central Committee against Tuberculosis (DZK) published its recommendations for drug treatment of tuberculosis (TB) in 2001 and for chemoprevention of latent tuberculosis infection (LTBI) in 2004. These international publications have been integrated in the present new recommendations which describe both the treatment of active TB and preventive treatment, pointing out specific adaptations for Germany. Separate sections deal with the current management of mono-, poly-, and multiresistance or drug intolerance, of TB in children, of different forms of extrapulmonary TB, of LTBI and of special situations such as HIV infection, renal or hepatic insufficiency, infection following BCG instillation in bladder cancer or in case of adverse drug reactions. The following aspects differ from the previous recommendations: A three-drug regimen for the so-called fully susceptible minimal TB is no longer recommended in adults. A dosage of 15 mg/kg body weight of ethambutol for adults is regarded as sufficient. Four secondline drugs (supplemented by pyrazinamide, where appropriate) are recommended for multidrug-resistant tuberculosis (MDR-TB). MDR-TB should be treated over a period of at least 20 months, with an injectable drug administered for a minimum of 8 months (initial phase). Ciprofloxacine and ofloxacine are no longer used to treat TB. It is also recommended to offer an HIV test to all TB patients to complement antiretroviral therapy, if necessary, and to adapt the antituberculous therapy accordingly.

/pdf/recommendations-for-therapy-chemoprevention-and-qrd4ni62t9.pdf

[Recommendations for therapy, chemoprevention and chemoprophylaxis of tuberculosis in adults and children. German Central Committee against Tuberculosis (DZK), German Respiratory Society (DGP)].

The bronchogenic cyst

Malaria and tuberculosis (TB) are two major global diseases mostly affecting the developing countries. Their treatment is often complex because of the drugs used, multidrug resistance, drug interactions and logistic problems such as drug availability and access. Patients are treated for TB for a minimum of 6 months and may concomitantly develop and be treated for malaria, especially during the rainy season. Rifampicin, a standard component of combination regimens for treating TB, is a potent inducer of hepatic cytochrome and other metabolic enzymes and is able to influence the pharmacokinetics of many drugs. Rifabutin, another rifamycin used less frequently than rifampicin, can also interact with drugs metabolized through the hepatic cytochromes. The mechanisms of any interaction of rifamycins with drugs used in malaria are not well defined. To complicate matters, acute malaria also plays a role in the pharmacokinetics and pharmacodynamics of drugs (i.e. quinine). The aim of this paper is to review known and potential drug-drug interactions between rifampicin, rifabutin and antimalarial drugs.

Pharmacokinetics and pharmacodynamics of drug interactions involving rifampicin, rifabutin and antimalarial drugs

Should asymptomatic bronchogenic cysts in adults be treated conservatively or with surgery

There is debate about which bronchial closure technique is the best to prevent bronchopleural fistulas (BPFs). We aim to assess the effect of bronchial closure procedures and patients' characteristics on BPF occurrence in pulmonary resections. Bronchial closures in 625 consecutive patients were assessed. Stumps were closed by manual suturing in 204 and by mechanical stapling in 421 cases. In the mechanical stapling group, stapling supported by manual suture was performed in 170 cases. BPFs occurred in 3.8%. Of these, stapling was used in 5.0%, whereas manual suturing was used in 1.5% (P=0.04). BPFs were more prevalent among patients who had undergone pneumonectomy (P<0.01), right pneumonectomy (P<0.01), stapler closure (P<0.01), patients with co-factors (P<0.01), and patients who had undergone preoperative neo-adjuvant (P=0.01) or postoperative adjuvant therapy (P=0.03). There was no difference in the frequency of BPF between patients with and without adjuvant support in the stapling group. The optimum bronchial closure method has to be chosen by considering the patient and bronchus based characteristics. This has to be assessed carefully, especially in pneumonectomy and co-factors. The manual closure seems to be the more preferable method in risky patients. An additive support suture on the bronchial stump does not decrease the risk of BPF.

/pdf/bronchial-closure-methods-and-risks-for-bronchopleural-54jy608j6t.pdf

Bronchial closure methods and risks for bronchopleural fistula in pulmonary resections: how a surgeon may choose the optimum method?

Primary hydatid cysts very rarely form in intrathoracic yet extrapulmonary sites. Accurate preoperative diagnosis in such cases is difficult, and corrective surgical procedures necessarily differ from those that are used to treat the far more typical pulmonary or hepatic hydatid cysts. We retrospectively evaluated the diagnostic and operative characteristics of intrathoracic extrapulmonary hydatid cysts, and we examined the outcome of aggressive surgical interventions that went beyond conventional parenchymal-sparing procedures.

From 2003 through 2007, 14 patients (mean age, 39.14 ± 16.8 yr) underwent surgical treatment in our hospital for primary intrathoracic extrapulmonary hydatid cysts. These cysts were variously in the diaphragm, chest wall, mediastinum, pleura, and pericardial cavity. All patients underwent cystectomy, decortication, resection, and repair of the adjacent structure. No complication, recurrence, or death occurred in the follow-up period of 15 ± 18.1 months (range, 2–52 mo).

In order to achieve complete resection and to avoid recurrence of disease from intrathoracic extrapulmonary hydatid cysts, the thoracic surgeon should forgo cystotomy and capitonnage in favor of cystectomy with a wide resection and reconstruction of surrounding tissues. Postoperatively, patients should adhere to a regimen of anthelmintic therapy.

Primary intrathoracic extrapulmonary hydatid cysts: analysis of 14 patients with a rare clinical entity.

Purpose
Social limitations in addition to treatment failure, despite preventive precautions and aggressive medical treatment, are the main indications for surgery in patients with bronchiectasis. The aim of this study was to evaluate all aspects of treatment outcomes in surgically treated patients with bronchiectasis.

Surgical Management of Bronchiectasis : The Indications and Outcomes

Rifabutin is a spiro-piperidyl-rifamycin derived from rifamycin-S. This study was planned to determine the minimal inhibitory concentrations (MICs) of rifabutin and rifampicin against Mycobacterium tuberculosis strains and to investigate cross resistance between two drugs. The agar dilution method was performed for detection of MICs of rifabutin and rifampicin for 112 M. tuberculosis strains obtained from patients with active pulmonary tuberculosis. Cross resistance between rifampicin and rifabutin was detected in 73.1%. Rifabutin MICs for rifampicin resistant strains were three- to four-fold higher than rifabutin-susceptible and/or -resistant strains' MIC values for rifampicin. Despite having 73% cross-resistance with rifampicin in M. tuberculosis isolates, it was concluded that rifabutin might be a valid component of combination therapy in rifampicinresistant tuberculosis cases when the isolate is tested and detected susceptible to rifabutin.

Incidence of cross resistance between rifampicin and rifabutin in Mycobacterium tuberculosis strains in Izmir, Turkey.

In secondary tuberculosis, lesions of the oral cavity may accompany lesions of the pharynx, lungs, lymph nodes or miliary tuberculosis. A 35-year-old male was suffering from swelling of his right cheek, cough, weakness and weight loss. There were local hyperemia and irregular oral mucous in the inner part of the right cheek. Chest x-ray showed bilateral nodular opacifications and a cavity of 2 cm. Acid-fast bacteria were present in sputum and Lowenstein-Jensen culture was positive. The pathological signs of the biopsy taken from the buccal mucosa including multistratified squamous epithelium were: tubercle structure, Langhans' giant cells and minimal cazeation necrosis. After anti-tuberculous chemotherapy oral and pulmonary lesions were almost in remission. Following this case report of lung tuberculosis accompanied by tuberculosis of oral mucosa, the literature related is reviewed.

Ahmet Emin Erbaycu

Papers

Bronchial closure methods and risks for bronchopleural fistula in pulmonary resections: how a surgeon may choose the optimum method?

Primary intrathoracic extrapulmonary hydatid cysts: analysis of 14 patients with a rare clinical entity.

Surgical Management of Bronchiectasis : The Indications and Outcomes

Incidence of cross resistance between rifampicin and rifabutin in Mycobacterium tuberculosis strains in Izmir, Turkey.

Tuberculosis of oral mucosa.