bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental and occupational lung diseases in Indonesia
Authors: MANGUNNEGORO Hadiarto , SUTOYO Dianiati Kusumo
Published: February 2008

Abstract
Indonesia as a developing country has air pollution which is mainly caused by motor vehicle emissions and industrial smoke. The most important indoor air pollution is cigarette smoke. The prevalence of smoking among Indonesian men is 45.7%. Of the population, 10.8% are ex‐smokers and 43.5% are non‐smokers. Among the female population, only 1.8% smoke. There are some important factors that influence the air pollution in Indonesia; this paper identifies the real problems and their impact. The paper reviews various studies that have been carried out in Indonesia which were related to ambient air quality, industrial air pollutants and the respiratory problems resultant. From all available data, it is concluded that the air pollutants levels (SO2, NOx, Ox, Pb, CO, HC) in large cities in Indonesia have exceeded the acceptable level, especially in industrial trade and heavy traffic areas. The more cigarettes inhaled and the deeper the inhalation, especially the kretek cigarettes, the risk of lung function abnormality becomes greater. Smoking high dose kretek cigarettes, that is ≥ 116 cigarettes/day x years, the risk of abnormal lung function is 13‐fold that of a non‐smoker; if added with the deep inhalation of smoke, the risk becomes 20‐fold. Smoking increases the risk of occupational lung diseases. The level of dust in some industrial areas exceeded the standard level and correlated with respiratory problems. The existence of industry‐caused air pollution in the environment increased the incidence of obstructive airway diseases. We conclude that the main cause of air pollution in Indonesia is motor vehicle emissions, followed by industrial smoke. Cigarette smoke is also related to abnormal lung function.
Endobronchial tuberculosis
Authors: SHIM Young‐Soo
Published: February 2008

Abstract
Endobronchial tuberculosis (EBTB) is a highly infectious disease that remains a diagnostic challenge in the developed countries. It also presents as a troublesome therapeutic problem due to its sequelae of cicatrical stenosis. Due to the worldwide decrease of tuberculosis, diagnosis of EBTB is frequently delayed until the onset of serious bronchial stenosis with resultant atelectasis and bronchiectasis. The exact pathogenesis of EBTB is not yet completely understood and the course of EBTB differs according to the type. The prognosis of actively caseating type and edematous‐hyperemic type EBTB is grave, resulting fibrostenosis in two thirds of patients. Fibrostenotic type EBTB shows no change or worsening of stenosis. The prognosis is good for granular and non‐specific bronchitic type EBTB; however, the prognosis of tumorous type is poor, frequently resulting in bronchial stenosis despite adequate treatment. Antituberculous chemotherapy is effective in controlling the infection, but does not prevent residual bronchostenosis. Early treatment with steroid therapy is effective in certain groups of EBTB. Balloon dilatation and stent insertion is an effective treatment of bronchial stenosis if obstruction of the stent by granulation tissue overgrowth can be prevented. Future research should focus on the pathogenesis of bronchial inflammatory reaction and resulting fibrosis to prevent bronchial stenosis at the early stage.
Bronchiectasis and related disorders
Authors: Ip MSM , Lam WK
Published: February 2008

Abstract
Bronchiectasis is defined in current medical parlance as the abnormal and permanent dilatation of one or more bronchi, and in clinical practice, the condition is often characterized by features of chronic bronchial infection. Apart from occurring as a primary lung disease, bronchiectasis is a major component of two other disease entities, cystic fibrosis and diffuse panbronchiolitis. Although the three conditions have distinctly different underlying causes, they share the similarity of a predominantly neutrophilic airways inflammation, and the persistent bronchial infection by bacteria, in particular Pseudotnonas aeruginosa. Hence, new knowledge in one disease may be explored and applied in the others.
Diagnosis and treatment of bacterial pneumonia in Korea
Authors: HAN Yong‐Chol , WOO Jun‐Hee
Published: February 2008

Abstract
Even with advancements in knowledge the problem of pneumonia will not be eliminated. It should be understood who is at risk, why such people develop pneumonia, what causes the pneumonia, and respiratory infection should be managed and prevented. The relative frequency of the isolation of various etiologic agents that cause bacterial pneumonia differ according to age group, geography, socio‐economic status, underlying disease, time of year, and possible concomitant viral illnesses. Prompt identification of the causative agent is vital in the management of pneumonia. The present status of elucidating the etiologic agent is far from complete and recently, newer techniques using DNA probes and polymerase chain reactions were used for the identification of microbial pathogens. The timely use of appropriate systemic antibacterial therapy eradicates the pathogens. Considering the alterations of the etiologic agents of bacterial pneumonia and antibiotic susceptibilities, attention should be directed to the usage of antimicrobial agents in order to maximize the efficacy and the therapeutic implications.
Asthma and migration
Authors: LEUNG Roland
Published: February 2008

Abstract
The dramatic influx of immigrants from South‐East Asian countries into Australia over the past 20 years was associated with an increase in asthma and allergic disease amongst these immigrants. Epidemiological data showed that the prevalence rates of asthma and allergic disease increased with the duration of residence in Australia so that after 10 years in Australia, up to 60% of South‐East Asian immigrants developed hayfever while 15% had symptoms of asthma. Many immigrants developed these conditions for the first time after arrival in Australia suggesting that the environment plays an important role in the pathogenesis of asthma and allergy. While sensitization to inhalant allergens such as house dust mite and grass pollen are apparently important in some, other yet undefined local factors are likely to contribute significantly to the overall increase in prevalence. A prospective study designed to follow a group of migrants in areas where asthma and allergic disease are common such as Australia, may reveal the pathogenic role of the environment and provide valuable information that may explain the global distribution and increasing trend of asthma and allergies.
Effect of antibacterial antibody on bactericidal activities of superoxide and lysosomal enzyme from alveolar macrophages in rabbits
Authors: SUGA Moritaka , TANAKA Fujiho , MURANAKA Hiroyuki , NISHIKAWA Hiroshi , ANDO Masayuki
Published: February 2008

Abstract
Alveolar macrophages (AM) have many Fc receptors for IgG, but are less reactive to lymphokines. They have a well‐developed oxidative metabolism and contain large amounts of lysosomal enzyme. This suggests that the antibacterial antibody plays an important role in early resistance by AM to intracellular bacterial infection and that a bactericidal agent, dependent on oxygen and lysosomal enzyme, participates in the intracellular killing of bacteria in AM. We studied the effects of the antibacterial antibody on bactericidal activities of superoxide (O2−) and lysosomal enzyme from rabbit AM. The number of Listeria monocytogenes in AM increased after pretreatment with saline or normal IgG but decreased by 60% after pretreatment with anti‐Listeria and 120 min incubation. Alveolar macrophage‐phagocytized Listeria monocytogenes and Bacille Calmette Guérin (BCG) bound with antibacterial antibody enhanced release of O2−, and nitroblue tetrazolium (NBT) formazan reduced by O2− was observed around the bacteria in the phagosomes of AM. We also confirmed that Listeria and BCG were killed extracellularly by O2− released by a superoxide‐generating system in vitro and/or by lysosomal enzyme obtained from AM at a low pH. We concluded that the antibacterial antibody of the IgG class enhances the antibacterial activity of AM thereby increasing the production of O2− and lysosomal enzyme in the phagosome. This finding may be important in the early resistance to intracellular bacteria infection by AM in the alveolar spaces.
Respiratory insufficiency after abdominal surgery
Authors: HALL John C. , Tarala Richard A. , HALL Jane L.
Published: February 2008

Abstract
The objective of this study was to define the relationship between respiratory insufficiency (RI) and various putative risk factors for patients undergoing abdominal surgery. A review of 1332 adults undergoing abdominal surgery was undertaken. Information was collected in a unbiased, prospective and uniform manner with regard to baseline characteristics, perioperative events and adverse outcomes after surgery. Respiratory insufficiency was defined as either: a PO2 < 60 mm Hg, the performance of a tracheotomy, or endotracheal intubation for more than 24 h. The incidence of RI was 3% (40/1332). A logistic regression analysis only identified an American Society of Anesthesia (ASA) classification > 2 (P < 0.001) and the presence of chronic bronchitis (P= < 0.05) as significant risk factors. In addition, 33% (8/24) of the patients who developed postoperative intraperitoneal sepsis and 30% (14/47) of the patients who underwent a reoperation developed RI. It was concluded that patients with a significant systemic disease (ASA > 2), as well as patients with chronic bronchitis, should be the recipients of intense efforts to prevent pulmonary complications after abdominal surgery.
Detection of human T lymphotropic virus type I proviral DNA in patients with diffuse panbronchiolitis
Authors: MATSUSE Takeshi , FUKUCHI Yoshinosuke , HSU Chong‐Yu , NAGASE Takahide , HIGASHIMOTO Yuji , TERAMOTO Shinji , MATSUI Hirotoshi , SUDO Eiich , KIDA Kozui , MORINARI Hajime , FUKAYAMA Masashi , OUCHI Yasuyoshi , ORIMO Hajime
Published: February 2008

Abstract
In Japan a number of reported cases of diffuse panbronchiolitis (DPB) have been associated with human T lymphotropic virus type I (HTLV‐I) infection. In this study the hypothesis that HTLV‐I proviral DNA may be prevalent in DPB was examined using polymerase chain reaction (PCR) for the region of env or the two‐step PCR for the pX region of this virus. The presence of HTLV‐I proviral DNA was studied in the peripheral blood mononuclear cells (PBMC) obtained from 10 patients with DPB. The presence of proviral DNA in PBMC in 12 patients with chronic obstructive pulmonary disease (COPD), eight patients with idiopathic interstitial pneumonia (IIP), four patients with bronchiectasis, 12 patients with bronchogenic carcinoma and 47 subjects without pulmonary diseases were also studied as relevant controls. The lung tissue obtained from 11 patients with DPB, 12 patients with diffuse aspiration bronchiolitis (DAB) at autopsy, and the surgical lung samples obtained from 12 patients with bronchogenic cancer were also studied. Peripheral blood mononuclear cells obtained from one DPB patient and one bronchogenic carcinoma patient were positive for the HTLV‐I pX region. The presence of the pX region was also found in the lung tissue of three DPB patients (27.3%) and one DAB patient (8.3%). None of other subjects were positive for HTLV‐I proviral DNA. In conclusion, HTLV‐I is not the causative virus in the pathogenesis of COPD, IIP bronchiectasis and bronchogenic carcinoma. There is a likelihood that HTLV‐I infection is associated with some cases of DPB; however, this association needs further verification.
Tuberculosis antigen A60 serodiagnosis in tuberculous infection: Application in extrapulmonary and smear‐negative pulmonary tuberculosis
Authors: LUH Kwen‐Tay , YU Chong‐Jen , YANG Pan‐Chyr , LEE Li‐Na
Published: February 2008

Abstract
An ELISA diagnostic test for tuberculosis antigen A60 (TBA60) IgG/IgM was used in a tertiary referral hospital in Taiwan. From June 1992 to December 1993, serum samples obtained from 907 patients were analyzed for TBA60 IgG and IgM titres. The final diagnosis of these patients was confirmed by microbiological study and clinical follow up for 18–24 months. Among 147 patients with active pulmonary tuberculosis, IgG was positive in 112 (76.2%), IgM was positive in 14 (9.52%). Among 90 patients with active extrapulmonary tuberculosis, IgG was positive in 53 (58.9%), IgM was positive in 9 (10%). Among 153 patients with inactive tuberculosis, IgG was positive in 28 (18.3%), IgM was positive in 1 (0.6%). Among 517 patients with nontuberculous disease, IgG was positive in 50 (9.7%), IgM was positive in 3 (0.6%). In this study population with 26% (237/907) active tuberculous infection rate, the TBA60 ELISA IgG had a diagnostic sensitivity of 69.6% and a specificity of 92.1%. These results indicate a positive predictive value of 67.9% and a negative predictive value of 89.2%. The sensitivity of IgM was 10.5% and specificity, 99.4%. The serum IgG titre had good correlation with the extent of pulmonary disease. Patients with smear‐positive pulmonary TB had a higher percentage of IgG seropositivity (83.9%) than those with smear‐negative pulmonary TB (70.6%) and extrapulmonary TB (58.9%). In 50 cases with active tuberculosis, follow‐ up examinations were carried out one month after treatment. In 18 cases with initially negative IgG and IgM titres, 13 showed elevation of serum IgG titres into positive level, one had positive seroconversion of IgM which was the only serological marker indicating active infection. Therefore, 77.8% (14/18) gained diagnostic benefit from follow‐up serological examination. It was concluded that TBA60 IgG and IgM ELISA is a useful test when diagnosing tuberculosis. This test also assists in the clinical judgement of tuberculosis when used as an adjunct to symptoms and sputum smear, and for monitoring therapeutic response at the commencement of treatment.
Airway smooth muscle in asthma
Authors: BLACK Judith L , JOHNSON Peter RA
Published: February 2008

Abstract
One of the factors that may contribute to the exaggerated airway narrowing in asthma is an abnormality of the airway smooth muscle. This abnormality could take the form of an increase in the amount of muscle or an alteration in its pharmacological reactivity. The former could be due to either hypertrophy (an increase in individual muscle cell size) or hyperplasia (an increase in cell number). Changes in pharmacological reactivity that could be relevant to altered airway calibre could result from an increase in contraction or alternatively, a decrease in relaxation. Based on available evidence, the increase in smooth muscle bulk is probably the consequence of both hyperplasia and hypertrophy and several growth factors, inflammatory mediators and cytokines have been implicated. Asthmatic airway tissue is rarely available for in vitro pharmacological studies and evidence for enhanced contraction is limited. Recent evidence suggests that an abnormality in beta adrencoceptor function may contribute to impairment of relaxation, but further work needs to be done. Passive sensitization of non‐asthmatic airways in vitro provides a good model for the study of the mechanisms underlying airway hyperresponsiveness, and will be the subject of more intensive study in the future.
New insights into risk factors of asthma
Authors: ZHONG Nan‐Shan
Published: February 2008

Abstract
The prevalences of bronchial asthma in the Asia‐Pacific region range from 0 to 24% and appear to be increasing in some countries. The increased prevalence of asthma may be related to the urbanization of these countries or areas. Risk factors relating to the development of asthma are multiple and complex. These include: Predisposing or genetic factors: (atopy and bronchial hyperresponsiveness; BHR) that increase an individuals susceptibility. Longitutinal studies in children have shown that BHR precedes asthma in some individuals. A gene governing BHR is located near a major locus that regulates serum IgE levels on chromosome 5 q. An additional gene that determines the specificity of the immune response located in the human leukocyte antigen complex (HLA) may govern the specificity of the immune response to common aeroallengens in some individuals. Causal factors: inhaled allergens are the most important causal factors of asthma, which include indoor allergens (domestic mites, animal, cockroach and fungus allergens), domestic mites being the most common potential allergen, and outdoor allergens (pollens from trees, grasses and weeds). Owing to the geographic location and different sensitivity to allergen between races, allergens vary from area to area. Certain drugs, food and food additives are also the cause of asthma attack. Contributing factors: smoking is an important trigger and a serious problem in most Asian Pacific countries. Air pollution in particular sulfur dioxide (SO2), nitrogen dioxide (NO2) and respirating particles are common contributing factors. Very low concentration of SO2 (0.5 ppm) can cause bronchospasm in asthmatics. A combination of low concentration of SO2 and NO2 often encountered in heavy traffic further enhances the airway responsiveness to inhaled allergen. In addition, respiratory virus infection is closely associated to the development of asthma in childhood.
Craniofacial abnormalities in obstructive sleep apnoea: Implications for treatment
Authors: CISTULLI Peter A
Published: February 2008

Abstract
Obstructive sleep apnoea (OSA) is a common disorder, and is characterized by repetitive closure of the upper airway during sleep. Upper airway narrowing and sleep‐induced loss of muscle tone are important factors in the development of OSA. Over the last decade there has been a growing recognition that craniofacial abnormalities occur commonly in OSA patients. The more commonly identified abnormalities include mandibular deficiency, an inferiorly placed hyoid bone relative to the mandibular plane, a narrowed posterior air space, a greater flexion of the cranial base, and elongation of the soft palate. It is thought that these abnormalities result. in upper airway narrowing, thereby predisposing to OSA. When the well established role of obesity in the development of OSA is taken into account, a model of OSA emerges in which the degree of craniofacial abnormalities determines the extent of obesity required to produce OSA in a given individual. The recognition of the role of craniofacial abnormalities in the development of OSA has led to a number of treatment strategies aimed at correcting or improving craniofacial structure, thereby preventing upper airway collapse during sleep. These treatments include dental appliances, and various maxillofacial surgical procedures. An improved understanding of the evolution of OSA from childhood to adulthood, in relation to facial development, may lead to a preventative strategy for this disorder.
Exercise‐induced asthma and the use of hypertonic saline aerosol as a ronchial challenge
Authors: ANDERSON Sandra D
Published: February 2008

Abstract
Exercise induced asthma is a common complaint and the prevalence appears to be increasing worldwide. Once confined to the research domain of university teaching hospitals, the study of EIA has extended into the school playground, defence force establishments and sports institutions. Standardized protocols have been developed to study EIA in the laboratory and in the field. A surrogate challenge using eucapnic or isocapnic hyperventilation with dry air is becoming popular because it has advantages over exercise, at least for adults. The stimulus that leads the airways to narrow is caused by the inhalation of dry air during hyperventilation and exercise, during which water is evaporated from the airways in order to condition the inspired air. The mechanism whereby the airways narrow is thought to be due to the dehydrating effects of water loss, particularly in relation to its potential to cause the airways to become hyperosmolar. Mast cell mediators such as histamine and the leucotrienes are probably involved in EIA because specific antagonists reduce severity. As a result of the osmotic theory of EIA, studies were carried out to determine whether subjects with EIA were sensitive to the effects of increasing airway osmolarity by inhalation of hyperosmolar aerosols of sodium chloride. A challenge protocol using an aerosol of 4.5% sodium chloride, generated from an ultrasonic nebulizer, has been used to identify persons with asthma and to assess response to drug therapy. There are many similarities between responses to exercise, hyperventilation and hypertonic saline in the physiological and biochemical responses and the responses to drugs. Challenge with hypertonic saline is easier and cheaper to use because expensive equipment and a source of dry air is not required as with exercise or hyperventilation. The ability to obtain a dose‐response curve rather than a single response and the ability to collect inflammatory cells at the same time make challenge with hypertonic saline an attractive technique to study patients suspected of having asthma.
Problems of measuring asthma prevalence
Authors: KEMP Trudi , PEARCE Neil , CRANE Julian , BEASLEY Richard
Published: February 2008

Abstract
This review considers the issues involved in measuring the community prevalence of asthma, particularly in the context of international comparisons. We argue that there is no gold standard definition for measuring asthma prevalence, and discuss the currently available methods of case ascertainment. Prevalence studies, if they are to be generalizable, need to involve large sample sizes with high response rates. This necessitates methods that are simple, inexpensive and practicable, but also as sensitive and specific for asthma as possible. We discuss some of the issues that are specific to comparisons of asthma prevalence between diverse populations, and suggest that large surveys using written or video questionnaires of self reported symptoms validated in all of the target populations are the method of choice.
Treatment of severe exacerbation of chronic obstructive pulmonary disease with mask‐applied continuous positive airway pressure
Authors: LIM TK
Published: February 2008

Abstract
The efficacy of mask‐applied continuous positive airway pressure (CPAP) in the treatment of patients with acute severe exacerbations of chronic obstructive pulmonary disease (COPD) was examined. Ten patients with severe exacerbation of COPD who had deteriorated during conventional therapy were treated with face‐mask delivered CPAP (+5 cmH2 O; Downs Vital signs Inc., New Jersey, USA) instead of tracheal intubation and mechanical ventilation. The patients that were selected required mental alertness, intact upper airway reflexes, the clinical signs of dynamic hyperinflation and a positive end‐expiratory pressure auto‐(PEEP) manifested as expiratory wheeze and grunting. Nine out of 10 patients responded promptly to mask‐CPAP with less distress, better oxygenation, lower respiratory and pulse rates. There was no significant change in arterial carbon dioxide tension with mask‐CPAP treatment. One patient deteriorated on mask‐CPAP and required intubation and mechanical ventilation. Three patients died (none of these patients died during the acute period of exacerbation). It was concluded that Mask‐CPAP may be an alternative to mechanical ventilation in the treatment of selected patients with severe hypercapnic exacerbations of COPD.
Effects of thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis on bronchial responsiveness to histamine: Implications on the autonomic imbalance theory of asthma
Authors: NOPPEN Marc MP , VINCKEN Walter G
Published: February 2008

Abstract
Autonomic nervous system abnormalities in airway control may contribute to the symptoms of asthma, and even to the pathogenesis of bronchial hyperresponsiveness (BHR). Partial pulmonary sympathetic denervation by means of bilateral upper dorsal thoracoscopic D2–D3 sympathicolysis (TS) is an accepted treatment in severe essential hyperhidrosis (EH). The effects of this intervention on BHR are unknown. The objective of this study was to evaluate whether partial pulmonary sympathetic denervation by means of TS has an effect on BHR. Bronchial challenge tests with histamine, enabling the calculation of the provocative dose causing a 20% reduction in FEV1 (PD20 His) were performed 1 day before, and 6 weeks and 6 months after TS in 35 patients with severe EH. In nine patients (including three patients with a previous history of asthma) with pre‐operative BHR (defined as PD20 His < 2 mg), mean PD20 His did not change significantly at 6 weeks, nor at 6 months after TS (0.62 ± 0.33, 0.71 ± 0.42 and 0.93 ± 0.65 mg, respectively) although there was a non‐significant trend towards an increase in PD20 His at 6 months. Three of the 26 patients (12%) without pre‐operative BHR became hyperresponsive after TS, whereas 1 of the 9 patients with pre‐operative BHR lost hyperresponsiveness. No patient developed asthma symptoms after TS. Upper dorsal thoracoscopic D2–D3 sympathicolysis performed for the treatment of EH has no significant effects on mean PD20 His and individual loss (11%) or development (12%) of BHR occurs only in a minority of patients.
Clinical features predictive of exercise‐induced asthma in children
Authors: NOLAN P
Published: February 2008

Abstract
Exercise‐induced asthma (EIA) is a common symptom among young asthmatics. The hypothesis that asymptomatic day‐to‐day wide fluctuations in lung function and asymptomatic persistent airflow obstruction are risk factors for the development of EIA was studied. The study population was a cohort of known asthmatic children aged 9–14 years attending a residential asthma camp. The method involved the observation of baseline expiratory peak flow recordings (PEFR) for 5 days while the children were receiving their usual maintenance therapy. The method also included the determination of FEV1 pre‐ and post‐ 15 min of continuous aerobic exercise. Exercise‐induced asthma was expressed as the Lability index (LI). The findings were that LI was significantly correlated (P < 0.01) with the mean PEFR as a per cent of each child's predicted PEFR. The lability index also correlated (P < 0.01) with the degree of day‐to‐day variability in PEFR expressed as the coefficient of variance (CV). It is concluded that there is a significant correlation between baseline asthma control and the development of EIA. In addition to recommending pre‐exercise prophylaxis, practitioners should investigate overall asthma control in children reporting EIA.
When to suspect and how to diagnose pulmonary lymphangioleiomyomatosis
Authors: NAALSUND Anne , JOHANSEN Bjorn , FOERSTER Arnold , KOLBENSTVEDT Alf
Published: February 2008

Abstract
The objective of this study was to present clinical and radiological data of eight women with histologically proven lymphangioleiomyomatosis (LAM) diagnosed between 1984 and 1994, and to suggest a diagnostic strategy when LAM is suspected. A review of case reports, including results of biopsies, lung function and radiological procedures was undertaken. The mean age of the women at start of symptoms was 36 years, and the mean age at time of diagnosis 42 years. The most frequent presenting complaint was dyspnea, either in conjunction with pneumothorax (3), chylothorax (2) or on exertion (2). All patients had airflow limitation and markedly reduced gas transfer. Five patients had 16 episodes of pneumothorax. In seven patients multiple cysts were observed on the surface of the lung during thoracotomy while computerized tomography (CT) scans revealed numerous cysts evenly distributed throughout the lung parenchyma. The procedures that confirmed the diagnosis included transbronchial lung biopsy (4), open lung biopsy (2), thoracoscopy (1), thoracotomy (3) and autopsy (1). Three specimens had to be revised before the histological diagnosis was confirmed. It was concluded that the important clues to a diagnosis of LAM are recurrent episodes of pneumothoraces in fertile women, progressive air‐flow limitation, markedly reduced gas transfer and characteristic findings on thoracic CT scans. A specific request to the pathologist to stain lung tissue specimens for smooth muscle cells is mandatory.
Pulmonary lymphangioleiomyomatosis: Prolonged survival despite multiple pregnancies and no hormonal intervention
Authors: YIGLA Mordechai , BENTUR Lea , IZHAK Offer BEN , RUBIN Ami Hai E
Published: February 2008

Abstract
Pulmonary lymphangioleiomyomatosis (PLAM) is rare progressive, fatal interstitial lung disease, considered to be sex hormones related. We report a follow‐up, after 19 years, in a patient with PLAM without intervention. Despite excessive oestrogen production during four pregnancies there was only mild deterioration of her respiratory disease. Patients with good functional reserve should be followed‐up closely before deciding on hormonal ablative treatment.
Broncho‐mediastinal fistula following perforation of the oesophagus
Authors: MEYSMAN M , NOPPEN M , DELVAUX G , PETERS O , VINCKEN W
Published: February 2008

Abstract
We present a 63‐year old female with mediastinitis following an esophageal perforation, possibly favoured by an oesophageal motility disorder and the use of non‐steroidal anti‐inflammatory drugs, who developed a broncho‐mediastinal fistula in the left main bronchus. She was successfully treated with intravenous antibiotics, a cervical oesophagostomy and secondary isoperistaltic coloplasty.
Bronchiectasis: A neglected cause of respiratory morbidity and mortality
Authors: KOLBE John , WELLS Athol U
Published: February 2008

Abstract
Bronchiectasis is a progressive condition characterized by irreversible destruction and dilation of airways generally associated with chronic bacterial infections. Although in Western countries, the morbidity and mortality from bronchiectasis is considered to have declined markedly in the modern era, the condition continues to cause significant morbidity and mortality in the south‐west Pacific and probably also in South‐East Asia. There is a high prevalence in indigenous populations in the region and factors such as poverty, substandard housing, malnutrition, barriers to medical care and inadequate education are all likely to have a major impact on prevalence and outcome of bronchiectasis. Although bronchiectasis has been viewed as a disease of medium and large airways, there is now increasing evidence of the importance of small airways disease in bronchiectasis and that it may play an integral role in pathogenesis. Chronic inflammation of the bronchial wall by mononuclear cells is common to all types of bronchiectasis. A vicious cycle of bacteria (mediated lung toxicity and bacteria) provoked, host‐mediated inflammatory lung damage has been described. If progressive lung damage with its attendant morbidity and mortality is to be prevented, this vicious cycle needs to be broken. The two distinct therapeutic goals in bronchiectasis are to reduce morbidity and to prevent progression of underlying disease. It may be possible to modulate the host response directly and thus reduce tissue damage, but the precise role of immuno‐modulatory therapy in bronchiectasis is still unclear. The management of this hitherto neglected disease, which reaches almost epidemic proportions in some ethnic groups and is an ongoing source of considerable morbidity and mortality, requires a comprehensive, multidisciplinary approach, which can be modelled on the successful management of chronic asthma in New Zealand.
Cryptogenic fibrosing alveolitis: Have we made any progress?
Authors: LAKE Fiona R
Published: February 2008

Abstract
The interstitial lung diseases (ILD) are a heterogeneous group of disorders the most common of which is cryptogenic fibrosing alveolitis (CFA). This article has summarized recent work in particular on the diagnosis, pathogenesis and treatment of CFA, by reviewing published data accessed through Medline searching. Recent reports suggest a higher prevalence of CFA than previously documented (13.2–20.2/100000 population) and a rising mortality rate. The prognosis is universally poor with 50% of patients dying within 5 years. Although approximately 30% of patients may live for long periods (> 10 years), morbidity is significant and quality of life in the long‐term survivors is poor. Diagnosis is traditionally based on an open lung biopsy, however, more recently the high resolution computer tomography (HRCT) is often used; however, its use without a tissue diagnosis remains controversial. In conclusion, we know substantially more about the pathogenesis of the disease and from this work have a number of possibilities for new therapeutic strategies that will hopefully reach the bedside in the near future. Additionally we have some new non‐invasive tests that offer hope for stratifying patients but require further evaluation. For assessing both therapy and investigations we will need substantial groups of patients in multicentre studies to provide sufficient power to allow a conclusion to be reached. To ensure any further progress we must collaborate and enter our patients into such trials.
Bronchoalveolar lavage in asthma research
Authors: WALTERS E Haydn , WARD Chris , LI Xun
Published: February 2008

Abstract
A great deal of information about the pathophysiology of asthma and its treatment have been obtained through the use of bronchoalveolar lavage (BAL), especially in combination with airway biopsies. The introduction of highly sophisticated methods for examining BAL aspirate, including fluorocein activated cell scanning (FACS) analysis and molecular biology techniques has emphasized the potential power of this method of airway investigation. For those contemplating the use of BAL in asthma research programmes, we hope that this review will provide a useful insight into the current state of knowledge about the technique and its application, and that it will provide a solid platform for study design.
Pulmonary surfactant: No mere paint on the alveolar wall
Authors: NICHOLAS Terence E
Published: February 2008

Abstract
The gas‐liquid interface within the alveolus is completely lined with a complex mixture of lipids and unique proteins termed pulmonary surfactant, which both reduces surface tension and permits it to vary directly with the radius of curvature. In this way it minimizes the work of breathing and permits alveoli of different sizes to exist in equilibrium. However, surfactant does far more in that it also controls fluid balance in the lung and appears to play a key role in host defence. Either a deficiency in surfactant or an aberrant surfactant results in atelectasis and oedema. The surfactant system is very dynamic: alveolar surfactant phosphatidylcholine, the principal component, having a half life of only a few hours, with as much as 85% being recycled. Although distortion of the alveolar type II cell is now accepted as the principal stimulus for release, much remains to be discovered of modulating factors and intracellular signalling in the control of surfactant homeostasis. Likewise, many questions remain concerning the control of synthesis of the surfactant phospholipids, neutral lipids and proteins and their assembly into the tubular myelin form of alveolar surfactant, the refining of the monolayer with breathing, the control of re‐uptake of different components into the type II cells and the roles of the proteins.
Pleural mesothelioma: An approach to diagnostic problems
Authors: WANG Nai‐San
Published: February 2008

Abstract
In the 1960s, a close relationship between heavy exposures to crocidolite asbestos and mesothelioma was established. The debate on the diagnosis of mesothelioma became complicated because of the possibility of litigation. Well differentiated mesothelioma cells are mucicarmine negative but alcian blue and periodic acid–Schiff (PAS) positive, which are removed by hyaluronidase and diastase digestion. By electron microscopy (EM), they show bush‐like elongated, slender, and branching microvilli. By immunohistochemistry they express both keratin and vimentin but not carcinoembryonic antigenicity (CEA), B72.3, Ber–EP4, and Leu‐M1. In poorly differentiated mesotheliomas, chromosomal and molecular biological alterations are common and complex but these alterations also overlap with that of poorly differentiated tumours of the lung and other organs. A poorly differentiated pleural tumour is most likely metastatic and needs good team work to locate the primary site. The diagnosis of a mesothelioma and asbestosis should be established separately. Future studies will be focused less on the phenotypic differences but more on the broad molecular and multi‐phasic mechanisms of carcinogenesis, irrespective of the aetiological agents, in poorly differentiated tumours.
Use of the Sensormedics MCT accelerator™ in sputum induction
Authors: McCLEAN Melissa A , FIELD Penelope I , MATHESON Melissa J , SIMMUL Rein , BEREND Norbert
Published: February 2008

Abstract
Airway inflammation can be studied by obtaining sputum induced by inhalation of 3% saline. The Sensormedics MCT accelerator™ is an oral asymmetrical high frequency oscillator which safely enhances clearance of airway secretions. The aim of this study was to determine if use of the MCT Accelerator™ enhances sputum production in non‐asthmatic non‐atopic, atopic and asthmatic subjects. Fifteen subjects were studied over 3 days. On day 1 skin prick testing to common aeroallergens and methacholine bronchial reactivity were performed. On days 2 and 3, separated by 7 days, sputum was induced by inhalation of 3% saline alone for 30 mins or via the nebulizer port of the MCT Accelerator™ The cellular profile and volume of sputum were analysed. The use of the MCT Accelerator™ did not alter the cellular profile of the induced sputum nor was there an increase in volume. In conclusion the induction of sputum by inhalation of 3% saline was not altered by use of the MCT Accelerator.™
Clinical evaluation of serum type IV collagen 7S in idiopathic pulmonary fibrosis
Authors: KASUGA Ikuma , YONEMARU Makoto , KIYOKAWA Hiroshi , ICHINOSE Yuichi , TOYAMA Keisuke
Published: February 2008

Abstract
Type IV collagen is one of the major components of the basement membrane (BM). 7S domain (7S collagen) of type IV collagen is an N‐terminal peptide which is stable against protease and heat. We investigated serum concentration of 7S collagen in patients with idiopathic pulmonary fibrosis (IPF) and other pulmonary diseases. The aim of this study was to evaluate whether changes in the serum concentration of 7S collagen reflect the fibrotic process of IPF. We measured the concentration of serum 7S collagen with radioimmunoassay in patients with IPF, chronic pulmonary emphysema (CPE), sarcoidosis, infectious pulmonary diseases (IPD) and normal healthy controls. We also monitored 7S collagen during the clinical course in some patients with IPF and investigated the correlation between the serum 7S collagen, and lactate dehydrogenase (LDH) and erthrocyte sedimentation rate (ESR) in patients with IPF. Patients with IPF showed significantly higher serum concentration of 7S collagen than other pulmonary diseases and healthy controls. The serum concentration of 7S collagen significantly decreased in IPF patients who showed roentgenographic improvement after corticosteroid treatment. There was a correlation between the serum 7S collagen and LDH, and ESR. In conclusion, serum concentrations of 7S collagen increase in patients with IPE The measurement of 7S collagen is useful for the evaluation of fibrotic change in the lung.
Results of surgical treatment of 107 patients with complications of pulmonary tuberculosis
Authors: WU MinG‐HO , LIN Mu‐Yen , TSENG Yau‐Lin , LAI Wu‐Wei
Published: February 2008

Abstract
The objective of this study was to evaluate the results of surgical intervention performed on 107 patients with pulmonary tuberculosis complications. Between September 1988 and December 1995, 107 patients underwent a total of 126 operations for major complications of pulmonary tuberculosis. One hundred and twenty‐six operations consisted of lobectomies only or plus other lung resections performed in 55 cases, pneumonectomies in 20 cases, segmentectomies in 18 cases, wedge resections in two cases, tracheobronchoplasties in four cases, decortications in two cases, cavernostomies with concomitant muscle transpositions in seven cases, thoracoplasties reserved for the previously failed operations or to be a supplement for pulmonary resections in 18 cases. The operative mortality rate was of 1.8%, and the major complication rate was of 16.8%. Twenty‐eight (26.1%) patients with tuberculosis bacilli in sputum before operation have converted except one diabetic patient. In conclusion, surgery is indicated in pulmonary tuberculosis complications that are life‐threatening or unresponsive to chemotherapy. Pulmonary resection is the procedure of choice for most cases that require surgery.
Risk factors for asthma among young adults in Melbourne, Australia
Authors: ABRAMSON Michael , KUTIN Jozica J , RAVEN Joan , LANIGAN Anna , CZARNY Daniel , WALTERS E Haydn
Published: February 2008

Abstract
Asthma is more prevalent in Australia than in Europe or North America. As part of the European Community Respiratory Health Survey (ECRHS), we investigated exposure to risk factors for asthma among young adults in Melbourne. During this study, 553 randomly selected and 204 symptomatic participants aged between 20 and 44 years completed a detailed respiratory questionnaire, of whom 675 underwent measurement of bronchial hyperreactivity (BHR) by methacholine challenge and 745 had skin prick tests for atopy. Current asthma, defined as BHR and wheeze in the preceding 12 months, was present in 25.5% of those tested. A family history of asthma was a risk factor for current asthma (maternal asthma odds ratio [OR] 2.4, paternal asthma OR 2.1). Current smokers were 1.7 times more likely to have current asthma. A serious respiratory infection before 5 years of age increased the risk of current asthma 2.3‐fold. Atopy on skin testing was also strongly associated with current asthma (OR 5.9). The greatest risks were associated with positive skin tests to Cladosporium, house dust mite, cat and rye grass pollen. We conclude that female gender, maternal asthma, smoking, hayfever, early respiratory infection, occupational exposure and atopy are important risk factors for asthma in young adults.
Chronic lymphatic leukaemia presenting as severe obstructive sleep apnoea
Authors: NOLAN P
Published: February 2008

Abstract
A case of adenotonsillar enlargement from chronic lymphatic leukaemia leading to severe obstructive sleep apnoea (OSA) is described. Nasal continuous positive airway pressure (nCPAP) therapy was poorly tolerated because even at high pressures (+ 15 cm H2O) obstructive hypopnoeas persisted. Tonsillectomy resulted in significant improvement, though OSA persisted. nCPAP was reintroduced and at low pressures (+ 6 cm H2O) was efficacious in alleviating the patient's symptoms. This report highlights the need to consider OSA as a cause of constitutional symptoms in adults with lymphoreticular disease, especially where there is involvement of Waldeyer's ring.
Chronic solitary pulmonary nodule due to unsuspected pulmonary infarction from silent pulmonary embolism
Authors: SATO Hidetaka , MIKI Makoto , NAKAYAMA Shohichi , ABE Tatsuya , OHUCHI Hiroshi , ISAWA Toyoharu , NUKIWA Toshihiro
Published: February 2008

Abstract
A case of pulmonary embolism showing a longstanding solitary pulmonary nodule is presented. An asymptomatic 57 year‐old man with a solitary nodule in the right lower lobe was referred to our hospital. A pulmonary perfusion‐ventilation scan following a sudden onset of dyspnoea established the diagnosis of recurrent pulmonary embolism. The nodule gradually disappeared after anticoagulant treatment, indicating that the nodule was pulmonary infarction from silent pulmonary embolism. Although the incidence of pulmonary infarction is low in Japan, this case suggests that pulmonary infarction from silent pulmonary embolism should be considered as one important cause of a solitary pulmonary nodule.
Childhood antecedents of adult respiratory disease
Authors: STICK Stephen M
Published: February 2008

Abstract
This review examines the relations between early childhood lower respiratory symptoms and adult respiratory disease. The problems associated with investigating potential associations between respiratory disease in children and adults are discussed. Some studies have limitations because they are retrospective and early childhood respiratory symptoms have not been accurately diagnosed. Therefore, in this review, particular attention is paid to longitudinal studies (some from birth) that have used strict diagnostic criteria for respiratory episodes. These studies provide unique insights into the risk factors for the development of childhood respiratory problems and for persistence of symptoms into adulthood. Although cross‐sectional studies have indicated that early childhood respiratory disease is more frequent in adults with respiratory disease, evidence from longitudinal studies suggests that respiratory symptoms such as wheezing, are transient in the majority of infants and result from developmentally small airways. These longitudinal investigations have also indicated that persistence of symptoms into later childhood is associated with atopy. The important role of cigarette‐smoke exposure as a risk factor for abnormal pulmonary development, persistence of respiratory disease and reduction in lung function is discussed. The discovery of genetic markers associated with respiratory syndromes such as asthma, should facilitate studies that investigate the childhood antecedents of adult respiratory disease. Future longitudinal studies using genetic markers, will allow relations between specific genotypes and phenotypic outcomes to be examined.
Genetic factors in lung disease: Atopy and bronchial asthma
Authors: KAWAKAMI Yoshikazu , YAMAGUCHI Etsuro , MUNAKATA Mitsuru , DOSAKA‐AKITA Hirotoshi , FURUYA Ken
Published: February 2008

Abstract
Atopy defined as high IgE responsiveness has now been subject to genetic studies at the molecular level owing to the development of a great number of DNA markers over the human genome. Either by linkage analysis or by association study strong candidate genes of atopy have been proposed to be located on chromosomes 11q13 and 5q31 where high‐affinity IgE Fc receptor β subunit and allergy‐associated cytokines, respectively, have been mapped. Meanwhile, we found a novel association between one of alleles of D11S97, an anonymous DNA marker on 11g13, and high total serum IgE in a large number of Japanese general population and atopic family members. However, failure to replicate linkage or association studies by different investigators suggest polygenic nature of atopy. In addition to the genes regulating IgE synthesis, the requirement of local (pulmonary) genetic factors in the development of bronchial asthma have been speculated. Linkage analysis suggested possible existence of gene(s) regulating susceptibility and/or clinical characteristics of bronchial asthma also on chromosome 5q. One of the candidate is β2‐adrenergic receptor gene polymorphism. Mutated gene transfection studies suggested functional significance of some polymorphisms and clinical evaluations have revealed their contribution to airway responsiveness and severity of asthma.