bluuebunny/crossref_metadata_2025 huggingface dataset:
Proteinase-antiproteinase balance in tracheal aspirates from neonates
Authors: Sluis KB , Darlow BA , Vissers MC , Winterbourn CC
Published: June 2004

We wanted to identify the inhibitors of neutrophil elastase, quantify their activities in the upper airways of neonates, and relate these to the presence of active elastase and the likelihood of elastolytic injury occurring due to inhibitory capacity being overwhelmed. Activities of neutrophil elastase and its inhibitors were measured in tracheal aspirates from 17 infants, 10 of whom subsequently developed bronchopulmonary dysplasia. All aspirates contained immunologically detectable alpha 1-proteinase inhibitor (alpha 1-PI), but their inhibitory capacity against neutrophil elastase ranged from being undetectable to being in excess of the amount of alpha 1-PI detected immunologically. When the alpha 1-PI was removed from each of the aspirates, using a specific antibody, from 0-50% of the original activity remained, indicating the presence of another elastase inhibitor. Its properties were consistent with it being the low molecular mass, secretory leucoproteinase inhibitor (SLPI), also known as bronchial antileucoproteinase. The alpha 1-PI was from 0-100% active. Most of the inactive inhibitor was shown by western blotting to be complexed with elastase, with a small amount of cleaved material. There was no evidence of major oxidative inactivation. Free elastase was detected in only three of the aspirates; these had little or no detectable elastase inhibitory capacity, and most of their alpha 1-PI was complexed. Elastase load, comprising the sum of free and complexed elastase, correlated closely with myeloperoxidase activity, a recognized marker of inflammatory activity. Active SLPI levels showed a positive correlation with gestational age (r = 0.66). We conclude that most neutrophil elastase in the upper airways of ventilated infants is complexed.(ABSTRACT TRUNCATED AT 250 WORDS)
Plasma concentration of elastase-alpha 1-proteinase inhibitor complex in surfactant-treated preterm neonates with respiratory distress syndrome
Authors: Tegtmeyer FK , Moller J , Richter A , Wilken B , Fischer T
Published: June 2004

Although exogenous surfactant replacement improves respiratory distress syndrome (RDS) of immature neonates, it may not prevent subsequent lung damage and development of bronchopulmonary dysplasia associated with polymorphonuclear neutrophil (PMN)-activation. We therefore wanted to assess whether surfactant administration would be associated with activation of circulating PMNs. Since elastase-alpha 1-proteinase inhibitor (E-alpha 1-PI) has proved to be a sensitive indicator of intravascular PMN activation, we studied E-alpha 1-PI plasma concentration in preterm neonates during the treatment of RDS with a bovine surfactant preparation (group I: n = 23). Results were compared with those from a retrospective control group treated by ventilation alone (group II: n = 13), and with a reference group of 92 newborns (group III). Following surfactant administration, median E-alpha 1-PI concentration increased significantly (day 1 80.5 vs Day 2,234 micrograms.l-1), and exceeded the upper limit of the reference range of 274 micrograms.l-1 in seven patients, with a maximal value of 1,881 micrograms.l-1 after multiple surfactant administrations. In contrast, 12 infants from Group II showed no increase in median E-alpha 1-PI levels (Day 1,107 vs Day 2,107 micrograms.l-1), and remained within the reference range (Day 1,125 micrograms.l-1; Day 2,107 micrograms.l-1) of the 92 newborns without respiratory impairment, infection, birth-trauma or asphyxia. From these results, it is concluded that surfactant may trigger a transient, mainly local, inflammatory response, reflected by increased levels of E-alpha 1-PI, and may exert a dose-related pathogenic influence on the course and prognosis of RDS.(ABSTRACT TRUNCATED AT 250 WORDS)
Transcarinal needle aspiration biopsy in the staging of lung cancer
Authors: Vansteenkiste J , Lacquet LM , Demedts M , Deneffe G , Verbeken E
Published: June 2004

Lung cancer without distant metastasis often requires an invasive surgical procedure to document inoperability. In order to determine how often puncture biopsy was a valid substitute for a surgical procedure, we investigated the performance of endoscopic staging by means of transcarinal needle aspiration biopsy during rigid bronchoscopy. Eighty lung cancer patients with subcarinal lymph nodes visible on computed tomography (CT) scan were studied. Specimens were of histological quality (i.e. lymph node tissue) in 59 out of 80 (74%) patients, and showed malignant invasion of this lymph node tissue in 43 cases. Specimens of cytological quality (i.e. lymph node cells) were obtained in 13 out of 80 (16%) patients, and showed malignancy in 7 cases. Therefore, adequate evaluation of the subcarinal lymph nodes was possible in 72 out of 80 (90%) patients. In 50 of these 72, malignant mediastinal spread was proven, and further invasive surgical staging could be avoided. Subgroup analysis showed that this outcome tended to be more likely in patients with abnormal endoscopic appearance of the main carina, with locally extensive tumours, and with nonsquamous histology. These results indicate that transbronchial needle aspiration biopsy of subcarinal lymph nodes can be a valuable alternative to more invasive surgical staging in patients selected by CT scan.
Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home
Authors: Wijkstra PJ , Van Altena R , Kraan J , Otten V , Postma DS , Koeter GH
Published: June 2004

We have developed a rehabilitation programme at home and have investigated its effects on quality of life (QOL), lung function, and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). We studied 43 patients with severe airflow obstruction: forced expiratory volume in one second (FEV1) 1.3 +/- 0.4 l (mean +/- SD), FEV1/inspiratory vital capacity (IVC) 37 +/- 7.9%. After stratification, 28 patients were randomly allocated in a home rehabilitation programme for 12 weeks. Fifteen patients in a control group received no rehabilitation. The rehabilitation group received physiotherapy by the local physiotherapist, and supervision by a nurse and a general practitioner. Quality of life was assessed by the four dimensions of the Chronic Respiratory Questionnaire (CRQ). We found a highly significant improvement in the rehabilitation group compared to the control group for the dimensions dyspnoea, emotion, and mastery. Lung function showed no changes in the rehabilitation group. The exercise tolerance improved significantly in the rehabilitation group compared to the control group. The improvement in quality of life was not correlated with the improvement in exercise tolerance. Rehabilitation of COPD patients at home may improve quality of life; this improvement is not correlated with an improvement in lung function and exercise tolerance.
The adequacy of oxygenation in COPD patients undergoing long-term oxygen therapy assessed by pulse oximetry at home
Authors: Sliwinski P , Lagosz M , Gorecka D , Zielinski J
Published: June 2004

It is probable that some daily activities may cause marked falls in arterial oxygen saturation (SaO2) in patients undergoing long-term oxygen therapy (LTOT), despite good oxygenation at rest. We estimated the adequacy of LTOT in 34 randomly selected chronic obstructive pulmonary disease (COPD) patients at home by monitoring SaO2 continuously over 24 h. The subjects were also asked to complete a questionnaire listing frequent daily activities. Despite almost normal mean SaO2 (94%) at the beginning of recording (O2 2 l.min-1, at rest) the subjects studied spent 6.9 h below an SaO2 of 90%, with minimum SaO2 of 61%. On average we observed 10 episodes of desaturation in each patient over 24 h, both while breathing air and oxygen. The comparison of SaO2 recordings and questionnaires revealed the highest number of desaturations during sleep, followed by naps, watching the television, eating, washing and talking. The oxygen flow rate prescribed, based on blood gas measurements at rest, did not protect 85% of the patients studied from deep falls in SaO2 during daily life. An increase oxygen flow during some activities and during sleep is suggested.
Dyspnoea and flow-volume curve during exercise in COPD patients
Authors: Noseda A , Carpiaux JP , Schmerber J , Valente F , Yernault JC
Published: June 2004

The purpose of this study, in patients with chronic obstructive pulmonary disease (COPD), was to examine the relationship of dyspnoea, rated on a visual analogue scale (VAS), to 1) tidal ventilatory variables measured on exercise and 2) pre-exercise lung function. Twenty one patients (forced expiratory volume in one second (FEV1) mean (SD) 1.19 (0.32) l) were studied. During a preliminary test, the maximal workload was assessed and the upper end of the VAS was anchored. On the study day, the tidal flow-volume curve on exercise was monitored and dyspnoea was assessed serially every minute. In each individual, the relationship of dyspnoea to various tidal ventilatory variables was studied using linear regression analysis; results were reported squared correlation coefficients, slopes and dyspnoea thresholds. Subsequently, the relationship of slopes and thresholds to pre-exercise lung function was examined. In all patients, dyspnoea showed a close correlation with ventilation, tidal volume, breathing frequency and tidal flow. The tidal peak inspiratory flow was the best individual predictor of dyspnoea with a median r2 of 0.91. Patients with the poorest pre-exercise lung function exhibited the highest rates of increase in dyspnoea and the lowest thresholds, the strongest correlation being observed between the dyspnoea/ventilation slope and pre-exercise maximal peak inspiratory flow (r2 = 0.54). In conclusion, for individual COPD patients dyspnoea on exercise is closely related to inspiratory flow. The degree of pre-exercise ventilatory impairment accounts, at most, for only half of the variation in dyspnoea perception between subjects.
The effect of positive end-expiratory pressure on respiratory resistive properties in anaesthetized paralysed humans
Authors: Cohendy R , Ripart J , Eledjam JJ
Published: June 2004

The respiratory resistive properties of the normal human respiratory system are volume-dependent. The overall flow resistance (Rmax,rs) can be partitioned into airway resistance (Raw) and the additional resistance (delta Rrs) which may result from the viscoelastic properties of the respiratory system, from inequality of time constants (pendelluft), or from both. Because positive end-expiratory pressure (PEEP) increases end-expiratory lung volume and may equalize ventilation within the lungs, the effect of PEEP on Raw, delta Rrs, and their sum (Rmax,rs) was assessed in anaesthetized surgical patients without evidence of lung disease. Fifteen men were studied during paralysis and isoflow isovolume mechanical ventilation, using the end-inflation occlusion method. Ten men were studied with incremental levels of PEEP, up to 16 cmH2O (Group A). Five men were studied without PEEP (Group B). In Group A, Rmax,rs did not change with PEEP. In contrast, Raw decreased and delta Rrs increased significantly. Moreover, there was a linear relationship between PEEP and the contribution of delta Rrs to Rmax,rs. In Group B, Rmax,rs, Raw and delta Rrs, and the contribution of delta Rrs to Rmax,rs did not change. In both groups, atropine elicited a decrease in Rmax,rs, linked to a decrease in Raw, without any notable effect on the static elastance of the respiratory system (Est,rs) or on delta Rrs. We conclude that the overall flow resistance was not affected by PEEP. In contrast, PEEP clearly modified the contribution of its two components. The decrease in Raw with PEEP could have resulted, at least in part, from modification in the basal vagal tone.
Twitch potentiating effects of theophylline on rat diaphragm are enhanced by foreshortening
Authors: Gayan-Ramirez G , Buts N , Decramer M
Published: June 2004

In patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure, acute hyperinflation is likely to induce foreshortening of inspiratory muscles. Since no data are available on the effects of inotropic agents at lengths below the optimal length (Lo), we compared the effects of theophylline on forty rat diaphragm bundles placed at Lo and at 70% Lo. Twitches and tetanic stimulations were recorded before and after addition of theophylline, in concentrations of 20, 100, 200 or 400 mg.l-1. Compared with values obtained before theophylline, twitch tension (Pt) and maximal tetanic tension (Po) of the bundles placed at Lo slightly decreased at 20 and 100 mg.l-1 whereas a clear increase in Pt was obtained at 400 mg.l-1 (15 +/- 21% (mean +/- SD)). In contrast, Pt of the bundles placed at 70% Lo increased with all theophylline concentrations, and vastly more than at Lo (e.g. at 400 mg.l-1: 74 +/- 34%, p < 0.05); whereas Po slightly decreased, except at 400 mg.l-1. Moreover, the difference between the effects at Lo and at 70% Lo increased with increasing theophylline concentrations. We conclude that even at low, in vivo attainable serum levels, theophylline exerted greater positive inotropic effects on twitch tension (Pt) of rat diaphragm when foreshortened than when at optimal length.
Increased responsiveness to cholinergic stimulation of small compared to large diameter cartilaginous bronchi
Authors: Mitchell HW , Sparrow MP
Published: June 2004

Model studies incorporating known morphological properties of the airways predict different narrowing characteristics between large and small bronchi. However, the flow-response characteristics of airways from different regions in the bronchial tree are still unknown. We compared the responsiveness of large and small bore bronchi of the pig to luminal or adventitial stimulation by acetylcholine (ACh) during perfusion of the airways at optimal driving pressure. Subsequently, each segment was measured morphometrically. Resting flow through the lumen was directly related to the fourth power of the segment internal diameter (ID). The sensitivity of small bronchi (2.00 mm ID) to ACh applied adventitially was about 870 times greater than large (5.85 mm ID) with a longer latency time of contraction in large bronchi. When perfused luminally the sensitivity difference was 42 fold, and after removing the epithelium the sensitivity difference was reduced to approximately five fold. Maximum concentrations of ACh produced airway closure in small segments (100% reduction in flow) but in large segments a plateau developed at 60-90% flow reduction. Similar findings were obtained with carbachol. Morphometry of the airway wall showed increasing cartilage, mucosal and smooth muscle thickness with increasing diameter, but a decreasing relative wall area. The marked differences in sensitivity to narrowing between large and small bronchi are, in part, related to differences in morphological properties of the mucosa (the epithelium) and adventitia, and to airway location. Airway size plays an important role in the maximum response of airway narrowing, with small airways showing closure and large airways a plateau.
Rolipram, but not siguazodan or zaprinast, inhibits the excitatory noncholinergic neurotransmission in guinea-pig bronchi
Authors: Qian Y , Girard V , Martin CA , Molimard M , Advenier C
Published: June 2004

Theophylline has been reported to inhibit excitatory noncholinergic but not cholinergic-neurotransmission in guinea-pig bronchi. As theophylline might exert this effect through an inhibition of phosphodiesterases (PDE), and since many types of PDE have now been described, the aim of this study was to investigate the effects of three specific inhibitors of PDE on the electrical field stimulation (EFS) of the guinea-pig isolated main bronchus in vitro. The drugs used were siguazodan, rolipram and zaprinast, which specifically inhibit PDE types, III, IV and V, respectively. Guinea-pig bronchi were stimulated transmurally with biphasic pulses (16 Hz, 1 ms, 320 mA for 10 s) in the presence of indomethacin 10(-6) M and propranolol 10(-6) M. Two successive contractile responses were observed: a rapid cholinergic contraction, followed by a long-lasting contraction due to a local release of neuropeptides from C-fibre endings. Rolipram (10(-9) to 10(-6) M) but not siguazodan or zaprinast, inhibited the peptidergic contraction in a concentration-dependent manner. Conversely, the cholinergic response was unaffected. Contractile responses induced by exogenous acetylcholine (10(-8) to 10(-3) M) or [Nle10]NKA(4-10) (10(-10) to 10(-6) M) were also unaffected by rolipram, siguazodan and zaprinast (10(-7) M). These results demonstrate that concentrations of rolipram, similar to those which inhibit PDE, reduce the release of sensory neuropeptides from C-fibre endings, and suggest that the cyclic adenosine monophosphate (AMP) PDE type IV is specifically involved in this effect, as in other anti-inflammatory effects.
Expiratory capnography in asthma: evaluation of various shape indices
Authors: You B , Peslin R , Duvivier C , Vu VD , Grilliat JP
Published: June 2004

The shape of the capnogram is modified by airway obstruction, and the evaluation of this deformation, using measurable indices, could allow an indirect measurement of bronchial patency. A previous study undertaken in asthmatic subjects showed a good correlation between a capnographic index (end-tidal slope) and a spirometric parameter (forced expiratory volume in one second as a percentage of predicted (FEV1 %pred)) and suggested the study of other indices. The correlations between capnographic and spirometric indices were measured in 10 healthy subjects and 30 asthmatic patients. The usefulness of eight descriptive indices, analysing the successive phases of the capnogram, was assessed by measuring their reproducibility and their sensitivity to airway obstruction. The intraindividual and interindividual variabilities (Vi and VI) and the noise/signal ratio (Vi/VI) were measured by comparing the results of two successive capnographic measurements in 14 asthmatic subjects. The results show an increasing noise/signal ratio along the expiration (between 23 and 62%). Significant correlations between spirometry and capnography were found with all indices, but the strongest were observed with indices analysing the intermediate phase of the capnogram, that is the angle between the ascending phase (E2) and the alveolar plateau (E3). The correlations show that the analysis of the capnogram's shape is a quantitative method for evaluating the severity of bronchospasm. This ability, added to specific advantages (noninvasiveness, effort-independency, measurements during tidal breathing) opens new fields of application to capnography, such as measurement of bronchospasm in children and computerized monitoring of asthma.
The leukotriene-antagonist ICI-204,219 inhibits the early airway reaction to cumulative bronchial challenge with allergen in atopic asthmatics
Authors: Dahlen B , Zetterstrom O , Bjorck T , Dahlen SE
Published: June 2004

The hypothesis that cysteinyl-leukotrienes (LTC4, LTD4 and LTE4) are mediators of allergen-induced airway obstruction in asthmatics was tested with the specific receptor antagonist ICI-204,219, in a double-blind, placebo-controlled, randomized, cross-over bronchoprovocation study. On three occasions, cumulative bronchial challenge with specific allergen was performed in 10 males with mild allergic asthma. The first control session established the baseline provocative dose of allergen producing a decrease in forced expiratory volume in one second (FEV1) by 20% (PD20FEV1). The two rechallenges were performed 2 h after oral administration of placebo or 20 mg of ICI-204,219. The allergen dose-response relations were highly reproducible, producing PD20 values at the control session and after placebo treatment which varied by no more than 0.7-1.3 fold (95% confidence interval (95% CI)). After ICI-204,219, the median cumulated allergen dose was 5.5 fold higher, and the group geometric mean PD20 was increased 2.5 times. Furthermore, the recovery time after the immediate bronchoconstriction was shorter (40 vs 60 min). The wheal and flare responses to intradermally injected LTD4 were somewhat inhibited by ICI-204,219, whereas responses to histamine were unaffected. However, the findings suggest that skin testing with LTD4 is unlikely to predict the degree of leukotriene-antagonism in the airways. The findings confirm and extend the indications that cysteinyl-leukotrienes are important mediators of allergen-induced airway obstruction, and that leukotriene-antagonists should be evaluated as a potential new therapy in allergic asthma.
Hypothesis: excessive bronchoconstriction in asthma is due to decreased airway elastance
Authors: Bramley AM , Thomson RJ , Roberts CR , Schellenberg RR
Published: June 2004

Based on the strikingly different mechanical properties of airway smooth muscle preparations of different species, we hypothesized that a decrease in the elastance of nonmuscle elements within airway walls of asthmatics reduces the load limiting smooth muscle shortening, thereby allowing excessive smooth muscle shortening and bronchoconstriction. Full thickness, circumferentially cut, lobar bronchial preparations were obtained from one asthmatic and six nonasthmatic lobectomy subjects. Passive tension of the asthmatic preparation was less than that for any nonasthmatic preparation at all lengths below that for optimal force generation (Lmax). Maximal isometric force generation was greater in the asthmatic specimen (2.32 g) than in the nonasthmatic specimens (0.90 +/- 0.15 g), with stress threefold higher for the asthmatic tissue. Isotonic shortening of the asthmatic preparation was strikingly greater at starting lengths less than or equal to Lmax, with maximal fractional shortening being 31% versus 11 +/- 2% for nonasthmatic preparations. Morphometric analysis revealed no differences in cross-sectional areas of smooth muscle for asthmatic versus nonasthmatic preparations. We conclude that the reduced tissue elastance may account for the greater muscle shortening by placing a lesser load upon the smooth muscle. Airway inflammation in asthma may alter connective tissue matrix elements within airway walls leading to this decreased elastance and excessive smooth muscle shortening.
A multicentre comparison of the efficacy of terbutaline Turbuhaler and salbutamol pressurized metered dose inhaler in hot, humid regions
Authors: Lindsay DA , Russell NL , Thompson JE , Warnock TH , Shellshear ID , Buchanan PR
Published: June 2004

Twenty seven adults and 20 children with previously diagnosed stable asthma, using a salbutamol pressurized metered dose inhaler (P-MDI) and living in Cairns, Townsville and Southport, Queensland, Australia participated in a randomized, open-label cross-over comparison of terbutaline administered via Turbuhaler and salbutamol administered via P-MDI. The aim of the study was to compare the clinical effectiveness and patient acceptance of the two treatments in hot, humid regions. Terbutaline was administered via Turbuhaler and salbutamol via P-MDI on at least two occasions per day during each four week treatment period. Spirometry was performed at the start of the study, after the two week run-in and at the end of each treatment period. Patients used diary cards to record morning and evening peak expiratory flows, daily symptom scores and daily intake of beta 2 agonist medication. At the end of the study, patients answered a treatment preference question. Forty six patients completed the study. No statistically significant differences were observed between the two treatments in peak expiratory flow, change in morning peak expiratory flow pre- and post-beta-agonist, daily symptom scores, diurnal variability and spirometry. Forty four percent of patients preferred the terbutaline Turbuhaler and 39% preferred salbutamol P-MDI. Both agents were similarly tolerated. Terbutaline delivered by Turbuhaler is as clinically effective as salbutamol delivered by P-MDI in patients with asthma living in hot, humid regions.
Aetiological agents in occupational asthma
Authors: Chan-Yeung M , Malo JL
Published: June 2004

Occupational asthma has become the most prevalent occupational lung disease in developed countries. At present, about 200 agents have been implicated in causing occupational asthma in the workplace. These agents can be divided into two categories by their mechanism of action: immunological and nonimmunological. Immunological causes can be further divided into those that induce asthma through an immunoglobulin E (IgE)-dependent mechanism, and those that induce asthma through a non-IgE-dependent mechanism. In the latter category, specific IgE antibodies are found only in a small percentage of the patients with proven disease, even though the clinical picture is compatible with an allergic reaction. The immunological mechanism(s) responsible for these agents has yet to be identified. The best known example of nonimmunological asthma is Reactive Airways Dysfunction Syndrome (RADS) or irritant-induced asthma. In this review, examples of types of agents causing occupational asthma are discussed and a compendium table of aetiological agents is given.
From allergen sources to reduction of allergen exposure
Authors: Bessot JC , de Blay F , Pauli G
Published: June 2004

Allergen exposure plays a major role in the development of sensitization, inflammation and symptomatic asthma. The development of new means of detecting allergens has enabled the evaluation of the effect of a reduction in allergen exposure to be better assessed. In order to prevent allergen exposure it is necessary to determine the allergen sources and reservoirs to which avoidance measures should be directed. The allergen sources and reservoirs of mite, cat, dog, cockroach, rodent, mould and pollen allergens are briefly reviewed. The relationships between allergen exposure, sensitization, nonspecific bronchial hyperreactivity and asthma symptoms are discussed. Recognition of the risks, environmental control, and reduction in allergen loads should be among the objectives of asthma management.
Transit time indices derived from forced expiratory spirograms: repeatability and criteria for curve selection and truncation
Authors: Chinn DJ , Cotes JE
Published: June 2004

Transit time analysis applied to spirograms truncated with respect to volume, not time, could be informative in population surveys. The present paper asks the questions: How does averaging several forced expirations affect the within subject variability at different levels of truncation? If only one spirogram is analysed, how should it be chosen? Are the results likely to be influenced by prior bronchodilation? The subjects were 46 men, selected by stratified random sampling from a shipyard population. Spirograms were obtained in quintuplicate, on two occasions, an average of nine days apart. Using the three "best" spirograms, transit time indices were calculated from average moments and from single curves selected in eight different ways; the analyses were performed on complete expirations, and after truncation by volume at levels between 75-99% of forced vital capacity (FVC), and by time (at 6 s). Indices from averaged moments were found to be more reproducible and yielded higher intra-class correlations than indices from single curves. Of the latter, the curve selected as having the largest forced vital capacity also yielded acceptable results. Prior inhalation of a bronchodilator aerosol did not reduce the variability. The averaging procedure is recommended for respiratory surveys of working men. For this application, the optimal level of truncation appeared to be by volume at 90% FVC, but on theoretical grounds truncation at 75 and 99% of FVC could also be informative.
Value of bronchoalveolar lavage in lipidoses with pulmonary involvement
Authors: Tabak L , Yilmazbayhan D , Kilicaslan Z , Tascioglu C , Agan M
Published: June 2004

Adult lipid storage disorders with pulmonary involvement are rare and usually diagnosed at autopsy. We report a patient with splenomegaly and reticulonodular pattern on lung computed tomography. Bronchoalveolar lavage was performed and revealed the presence of lipid-containing foamy cells, with the demonstration of both periodic acid-Schiff (PAS) and scharlach red stain positive vacuoles in the cytoplasm of alveolar macrophages. The same cells were found in bone marrow biopsy. As in other rare disorders, bronchoalveolar lavage may be of diagnostic value in lipid storage disorders with pulmonary involvement.
Positional dyspnoea due to aneurysm of the thoracic aorta
Authors: Phillips GD , Smith EE , Millard FJ
Published: June 2004

Thoracic aortic aneurysms may produce breathlessness by compressing the tracheobronchial tree. We report a patient whose shortness of breath demonstrated a marked positional component, due to varying compression of her major airways by the lesion.
Haemoptysis and an abnormal X-ray after prolonged treatment in the ICU
Authors: van Kralingen KW , Hekker TA , Bril H , Strack van Schijndel RJ , Postmus PE
Published: June 2004

We describe a case of Nocardia bronchopneumonia occurring in a patient after 5 weeks of treatment in an ICU. The clinical features were haemoptysis and fever, and an aspecific coarse nodular pattern on the chest roentgenogram. The diagnosis was made, after death, by positive blood cultures for Nocardia asteroides and autopsy showing Nocardia bronchopneumonia.
The contradictory culture of teacher-based assessment: ESL teacher assessment practices in Australian and Hong Kong secondary schools
Authors: Davison Chris
Published: June 2004

A growing concern in teacher-based assessment, particularly in assessing English language development in high-stakes contexts, is our inadequate understanding of the means by which teachers make assessment decisions. This article adopts a sociocultural approach to report on the background and findings of a comparative study of ESL teachers’ assessment of written argument in the final years of secondary school in Australia and Hong Kong. Using verbal protocols, individual and group interviews and self-reports, the study explored the different assessment beliefs, attitudes and practices of teachers working with senior secondary Cantonese-speaking students acquiring English as a second language. The study found that the Australian teachers varied considerably in their approach to assessing student work with two somewhat conflicting assessment orientations revealed: the legalistic assessors who ‘ticked the boxes’ according to the published assessment guidelines and those assessors who relied much more on professional judgment. In Hong Kong, there was much more variability in the underlying assessment criteria with consensus reached through reference to community norms rather than explicit statements of performance. The article concludes that traditional notions of validity may need to be reconceptualized in high-stakes teacher-based assessment, with professional judgment, interaction and trust given much higher priority in the assessment process.
Teacher formative assessment and talk in classroom contexts: assessment as discourse and assessment of discourse
Authors: Leung Constant , Mohan Bernard
Published: June 2004

There is now widely recognized support for classroom-based formative teacher assessment of student performance as a pedagogically desirable approach to assessment which is capable of promoting learning. However, the highly localized and socially co-constructed nature of this type of assessment has raised conceptual and research issues that transcend the theoretical and epistemological concerns of the more established standardized language assessment. One such issue concerns the part played by classroom spoken discourse in the teaching-assessment interaction between teachers and students. This article argues that there is a need to develop theoretically informed research approaches to study how this type of assessment is accomplished through teacher-student discourse in the classroom. Using data collected in two multiethnic and multilingual elementary classrooms we present an analysis, drawing on systemic functional linguistics, to suggest an approach to empirical research and to discuss a number of teaching-learning and research methodological issues.
The development of assessment for learning: learning from the case of science and mathematics
Authors: Harlen Wynne , Winter Jan
Published: June 2004

This article introduces the ideas of ‘assessment for learning’ as a means whereby teachers can make their classroom assessment more directly focused on learners’ development and can actively involve learners in this process. Current practice in classroom assessment in England is described and the thinking that has led to a new emphasis on formative practices outlined. This is set in the context of recent research studies that have been influential in changing not only classroom practice but also the ‘lead’ set by Government in promoting effective practice. Several examples of assessment strategies are offered to illustrate the principles involved. Conclusions are suggested that show how these ideas could make learning more effective and learners more involved.
IVIG treatment for progressive stroke in the primary antiphospholipid antibody syndrome
Authors: Horn H C , Grau K , Junker P
Published: June 2004

A 32-year old woman with antiphospholipid antibody syndrome (APS) developed severe thrombocytopenia, elevated liver enzymes and progressive cerebral thrombosis a few days after preterm delivery by caesarean section. Her condition deteriorated despite treatment with low dose aspirin, anticoagulation by heparin and iv glucocorticoid administration. Intravenous immunoglobulin (IVIG) on three consecutive days was followed by rapid resolution of her neurological impairment and increasing platelets counts. The temporal association between IVIG and reversal of both neurological impairment and platelet number strongly indicates a specific effect of IVIG administration in this condition. It is proposed that IVIG therapy is considered as a therapeutic option in APS patients with progressive cerebral infarction despite optimal use of anticoagulant and immunomodulating agents.
Osteoporosis in systemic lupus erythematosus: factors associated with referral for bone mineral density studies, prevalence of osteoporosis and factors associated with reduced bone density
Authors: Pineau C A , Urowitz M B , Fortin P J , Ibanez D , Gladman D D
Published: June 2004

The purpose of this study was to evaluate the clinical characteristics of women with systemic lupus erythematosus (SLE) sent for a dual energy X-ray absorptiometry (DEXA) study, and to analyse the factors associated with a lower bone mineral density in these patients. Women with SLE who had a DEXA done between 1 January 1995 and 31 December 2000 were compared with those who did not have DEXA scans performed. SLE patients with osteoporosis (OP) were compared with those with a normal bone density. Of 516 women with SLE, 205 had a DEXA done. These patients had more traditional risk factors for osteoporosis, higher lupus disease activity, renal involvement, increased damage, higher mean steroid dose, increased use of immunosuppressants and occurrence of avascular necrosis. Of the 205 patients with DEXA, 18% had osteoporosis, 48.8% had osteopenia and 33.2% had normal bone mineral density. The two statistically significant predictors of a low bone density were a higher age at time of DEXA (P 1/4 0.0003) and a higher SDI score (P 1/4 0.0019). Osteoporosis is a significant comorbidity in SLE. Lupus patients referred for a DEXA have more traditional risk factors and use more corticosteroids. The main factors associated with a low bone density were however found to be age and increased damage. Interestingly, disease activity and corticosteroid use were not associated with osteoporosis in this study which may suggest other potential causes such as decreased physical activity associated with damage.
Validity of the Disease Repercussion Profile in patients with systemic lupus erythematosus
Authors: Sharpe L , Denton F , Schrieber L
Published: June 2004

The Disease Repercussion Profile (DRP) was developed for use with patients with rheumatoid arthritis (RA) and has been shown to be a valid and clinically useful assessment of patient-perceived handicap. This study aimed to determine whether the Disease Repercussion Profile was also suitable for use with patients with systemic lupus erythematosus (SLE). Sixty patients with a definite diagnosis of SLE from a consultant rheumatologist were recruited into the study. They completed a series of questionnaires that assessed quality of life, depression, anxiety, attitudes towards the illness and the DRP. Results showed that patients with SLE endorsed each of the six spheres of the DRP as being frequently affected by their illness. Activity was most often endorsed. Both relationships and social activity were equally frequently adversely affected, and more often affected than the remaining spheres of finance, emotions and appearance. However, as in RA, when any area of function was affected, it was rated as very important to the individual. Indicators of quality of life were reliably related to all areas of function, as was depression and attitudes towards illness. The present study indicates that the DRP does have relevance for patients with SLE. Strong correlations between quality of life indicators, depression, attitudes towards illness and DRP subscales and total score indicate that this measure is a valid tool to assess the effect of illness on individuals with SLE.
Anti-nuclear antibody, anti-DNA, and aCL in Graves’ disease patients treated with propyluracil or methimazole
Authors: Huang C-N , Hsu T-C , Chou H-H , Tsay G J
Published: June 2004

One hundred and forty patients with Graves’disease [32 new patients, 54 treated with propylthiouracil (PTU) for a mean of 27.2 months and 54 treated with methimazole (MMI) for a mean of 48.6 months] were tested for anti-thyroid microsomal antibody (AMA), anti-thyroglobulin antibody (ATA), thyroid binding inhibitory immunoglobulin (TBII), and the non organ specific autoantibodies [i.e., anti-nuclear antibody (ANA), anti-double stranded DNA antibody (anti-dsDNA Ab), anti-cardiolipin antibody (aCL Ab) and anti-β2-glycoprotein I antibody (IgG β2 GPI)]. Treatment with MMI or PTU produced a significant difference in IgG aCL Ab production but not in ANA, dsDNA Ab, IgM aCL or IgG β2 GPI. For those treated with MMI but not those treated with PTU, ANA and anti-dsDNA Ab were positively correlated. IgG and IgM aCL Ab were positively correlated overall and for those on MMI but not PTU treatment. No significant difference was found for any of the four non organ specific antibodies in AMA positive or negative patients but there was a significant difference in IgG aCL positivity rates for ATA positive and negative patients. On the other hand, ANA negative patients were significantly more likely to have higher TBII values. These results suggest that the appearance of the non organ specific autoantibodies is probably largely a coincidental effect of polyclonal activation - except, perhaps, for IgG aCL, which may be related to treatment.
Antiphospholipid antibodies in acute coronary syndrome
Authors: Veres K , Lakos G , Kerényi A , Szekanecz Z , Szegedi G , Shoenfeld Y , Soltész P
Published: June 2004

Antiphospholipid (aPL) antibodies entailing anticardiolipin (aCL) and anti-β2 glycoprotein I (anti-β2 GPI) antibodies may be involved in a number of vascular diseases including coronary artery diseases (CAD) or stroke. Here we assessed the presence of aPL antibodies in acute coronary syndrome (ACS). The frequency of anti-β2 GPI antibodies was significantly higher (14.4%) in ACS in comparison to control healthy subjects (2%). In addition, serum concentrations of anti-β2 GPI antibodies were also increased in ACS. Anti-β2 GPI antibodies of the IgA isotype might be the most relevant for the onset and outcome of ACS. Regarding subclasses of ACS, anti-β2 GPI IgA antibodies were elevated in unstable angina (UA) and myocardial infarction with ST elevation (STEMI), but not in myocardial infarction without ST elevation (NSTEMI). The involvement of anti-β2 GPI antibodies in ACS was more pronounced in men than women, and in younger rather than older patients. Finally, anti-β2 GPI antibodies in ACS were associated with previous stroke, but not with hypertension or previous myocardial infarction. Thus, anti-β2 GPI antibodies may be involved in the thrombotic events underlying ACS.
T-lymphocyte signalling in systemic lupus erythematosus: a lipid raft perspective
Authors: Jury E C , Kabouridis P S
Published: June 2004

In the last few years it has become clear that in cells of the immune system, specialized microdomains present in the plasma membrane, called lipid rafts, have been found to play a central role in regulating signalling by immune receptors. Recent studies have looked at whether lipid rafts may be connected to the abnormalities in signalling seen in T lymphocytes isolated from patients with systemic lupus erythematosus (SLE). These early findings show that in SLE T cells, the expression and protein composition of lipid rafts is different when compared with normal T cells. These results also demonstrate changes in the function and localization of critical signalling molecules such as the LCK tyrosine kinase and the CD45 tyrosine phosphatase.
Prevalence of autoantibodies against structure specific recognition protein 1 in systemic lupus erythematosus
Authors: Fineschi S , Borghi M O , Riboldi P , Gariglio M , Buzio C , Landolfo S , Cebecauer L , Tuchynova A , Rovensky J , Meroni P L
Published: June 2004

Antibodies (Abs) against the structure specific recognition protein 1 (SSRP1) were reported in a small systemic lupus erythematosus (SLE) series but not in other systemic autoimmune diseases. The aim of the study was to confirm the selective presence of anti-SSRP1 Abs in a larger SLE series and to evaluate their relationship with disease activity and other immune markers. Anti-SSRP1 Abs were investigated by a ‘home made’ ELISA in: 120 SLE, 65 rheumatoid arthritis (RA), 51 systemic sclerosis (SSc), 23 Churg-Strauss syndrome (CSS) and 40 idiopathic autoimmune urticaria (IAU) patients and 190 healthy controls. Sera from MRL lpr/lpr and Balb-c mice were also tested. Anti-SSRP1 Abs were detected in 43 SLE (35.8%), nine SSc (17.6%), eight RA (12.3%), six IAU (15%), three CSS (13%) patients and five healthy controls (2.6%). Antibody prevalence and titers were significantly higher in SLE patients than in sera from both normal and disease controls. Anti-SSRP1 Ab activity was also detected in sera from MRL lpr/lpr but not Balb-c mice. The antibodies did not correlate with the disease activity evaluated as the ECLAM index score and were more prevalent in patients without renal involvement. No correlation was found with other serum autoantibodies. Our results confirm that anti-SSRP1 Abs are associated with but not specific for the lupus disease.
Antimalarial lichenoid tissue reactions in patients with pre-existing lupus erythematosus
Authors: Geraminejad P , Stone M S , Sontheimer R D
Published: June 2004

Recently a number of cases of drug induction or exacerbation of lupus erythematosus (LE) specific skin disease have been described in the literature. Many of the responsible medications are also known for their ability to induce a lichenoid tissue reaction. Aminoquinoline antimalarials are currently the first line of therapy in cutaneous LE specific skin disease. Lichenoid tissue reactions are among the most common cutaneous side effects of aminoquinolone antimalarials. We report three cases of aminoquinolone antimalarial induced or exacerbated LE specific skin disease. We also review the pathophysiology of LE specific skin disease and propose a mechanism by which induction of the lichenoid tissue reaction may result in Koebnerization of LE specific skin lesions.
Sites in the imagination: the Beaumont Hamel Newfoundland Memorial on the Somme
Authors: Gough Paul
Published: June 2004

The Beaumont Hamel Newfoundland Memorial is a 16.5-hectare (40 acres) tract of preserved battleground dedicated to the memory of the 1st Newfoundland Regiment, who suffered an extremely high percentage of casualties during the first day of the Battle of the Somme in July 1916. Beaumont Hamel Memorial is an extremely complex landscape of commemoration where Newfoundland, Canadian, Scottish and British imperial associations compete for prominence. It is argued here that those who chose the site of the Park, and subsequently reordered its topography, helped to contrive a particular historical narrative that prioritized certain memories over others. In its design, the park has been arranged to indicate the causal relationship between distant military command and immediate front-line response, and its topographical layout focuses exclusively on a 30-minute military action during a 50-month war. In its preserved state the part played by the Royal Newfoundland Regiment can be measured, walked and vicariously experienced. Such an achievement has required close semiotic control and territorial demarcation in order to render the ‘invisible past’ visible, and to convert an emptied landscape into significant reconstructed space. This paper examines the initial preparation of the site in the 1920s and more recent periods of conservation and reconstruction. The author examines precedents for the preservation of battlefields, the spatiality of commemoration and the expectations aroused by such sites of memory. By focusing on the Beaumont Hamel memorial site the author explores several areas of contention: historical accuracy, topographical legibility and freedom of access.
Creating a temenos, positing ‘South Africanism’: material memory, landscape practice and the circulation of identity at Delville Wood
Authors: Foster Jeremy
Published: June 2004

Like other Dominion First World War memorials, the South African National Memorial at Delville Wood was a landscape in which nostalgic anti-modernism was tempered by the desire to posit a new kind of identity. Using the iconographic ‘invented memory’ of New Imperialism, it was designed to project a bifocal ‘colonial nationalism’ at a time when white identity and South African citizenship were at their most fluid. Delville Wood has both failed and transcended this goal. Over the last eight decades, while becoming one of the most popular destinations on the Western Front tourist circuit today, the site has mediated the ongoing evolution of South African nationhood as an imaginative dialogue between ‘Europe’ and ‘Africa’. Comparing Delville Wood to other Dominion memorials, the paper proposes that the site’s durable but mutable resonance has been sustained by echoes of decisions taken in the 1920s about landscape materiality and making which are sequentially revealed by the visitor’s journey to and through the site today. As a result, Delville Wood functions as a ‘memory theatre’, in which the topological trajectory continues to link auratic1 ‘locale’ and the modern spatial semiotic of ‘free uninterrupted flow’.