Endotracheal tube colonization in patients undergoing mechanical ventilation was investigated.In the first part of this prospective study, the airway access tube was examined for the presence of secretions, airway obstruction and bacterial colonization, in cases undergoing extubation or tube change. In the second part of the study, the sequence of oropharyngeal, gastric, respiratory tract and endotracheal tube colonization was investigated by sequential swabbing at each site twice daily for 5 days in consecutive noninfected patients.In the first part, it was noted that all airway access tubes of cases undergoing extubation had secretions lining the interior of the distal third of the tube which were shown on scanning electron microscopy to be a biofilm. Gram-negative micro-organisms were isolated from these secretions in all but three cases. In the second part, it was noted that the sequence of colonization in patients undergoing mechanical ventilation was the oropharynx (36 h), the stomach (36±60 h), the lower respiratory tract (60±84 h), and thereafter the endotracheal tube (60±96 h). Nosocomial pneumonia occurred in 13 patients and in eight cases identical organisms were noted in lower respiratory tract secretions and in secretions lining the interior of the endotracheal tube.The endotracheal tube of patients undergoing mechanical ventilation becomes colonized rapidly with micro-organisms commonly associated with nosocomial pneumonia, and which may represent a persistent source of organisms causing such infections. Eur Respir J 1999; 13: 546±551.

No abstract

We describe a patient with inflammatory pseudotumour of the lung. He was a young man who presented with haemotysis and the chest X-ray and computerized tomography were indicative of a nonbenign lesion in the right upper lobe. Excision biopsy confirmed the diagnosis of inflammatory myofibroblastic pseudotumour of the lung. This is a rare inflammatory nonneoplastic condition commonly affecting children and young adults.

C Cr ry yp pt to oc co oc cc co os si is s: : a an n u un nu us su ua al l c ca au us se e o of f e en nd do ob br ro on nc ch hi ia al l o ob bs st tr ru uc ct ti io on n P. Mahida, R. Morar, A. Goolam Mahomed, E. Song, J.P. Tissandie, C. FeldmanCryptococcosis: an unusual cause of endobronchial obstruction. P. Mahida, R. Morar, A. Goolam Mahomed, E. Song, J.P. Tissandie, C. Feldman. ©ERS Journals Ltd 1996. ABSTRACT: We report the case of a 43 year old male patient, with normal immune function, who presented with right middle and lower lobe collapse.At bronchoscopy, a white lobulated lesion was seen, completely obstructing the origin of bronchus intermedius. Bronchial washings and biopsy of the lesion demonstrated cryptococcal organisms.The patient responded clinically and radiologically to amphotericin B and flucytosine; however, repeat bronchoscopy revealed only partial resolution of the endobronchial lesion.

Markers of disease severity appear to be the most important predictors of outcome in patients with severe community-acquired pneumonia.