bluuebunny/crossref_metadata_2025 huggingface dataset:
Daily variations in air pollution and respiratory health in a multicentre study: the PEACE project. Pollution Effects on Asthmatic Children in Europe
Authors: Roemer W , Hoek G , Brunekreef B , Haluszka J , Kalandidi A , Pekkanen J
Published: November 2002

The Pollution Effects on Asthmatic Children in Europe (PEACE) study is a multicentre study of the acute effects of particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10), black smoke (BS), sulphur dioxide (SO2) and nitrogen dioxide (NO2) on the respiratory health of children with chronic respiratory symptoms. The study was conducted in the winter of 1993/1994 by 14 research centres in Europe. A total of 2,010 children, divided over 28 panels in urban and suburban locations, was followed for at least 2 months. Exposure to air pollution was monitored on a daily basis. Health status was monitored by daily peak expiratory flow (PEF) measurements and a symptom diary. The association between respiratory health and air pollution levels was calculated with time series analysis. Combined effect estimates of air pollution on PEF or the daily prevalence of respiratory symptoms and bronchodilator use were calculated from the panel-specific effect estimates. Fixed effect models were used and, in cases of heterogeneity, random effect models. No clear associations between PM10, BS, SO2 or NO2 and morning PEF, evening PEF, prevalence of respiratory symptoms or bronchodilator use could be detected. Only previous day PM10 was negatively associated with evening PEF, but only in locations where BS was high compared to PM10 concentrations. There were no consistent differences in effect estimates between subgroups based on urban versus suburban, geographical location or mean levels of PM10, BS, SO2 and NO2. The lack of association could not be attributed to a lack of statistical power, low levels of exposure or incorrect trend specifications. In conclusion, the PEACE project did not show effects of particles with a 50% cut-off aerodynamic diameter of 10 microm, black smoke, sulphur dioxide or nitrogen dioxide on morning or evening peak expiratory flow or the daily prevalence of respiratory symptoms and bronchodilator use.
Seasonal variations in hospital treatment periods and deaths among adult asthmatics
Authors: Harju T , Tuuponen T , Keistinen T , Kivela SL
Published: November 2002

The purpose of this study was to examine possible seasonal variations in relations between hospital treatment periods and in deaths (asthma-related and other) among adult asthmatics. Out of a total of 364,871 asthma-induced hospitalization periods (diagnosis No. 493, International Classification of Diseases) recorded in the hospital discharge register maintained by the National Research and Development Centre for Welfare and Health during 1972-1992, all of those applying to persons aged >24 yrs during 1987-1992 were analysed here. The discharge file was linked to the register of deaths on the basis of the patients' social security numbers in order to analyse all deaths among the same patients during 1987-1993. A total of 81,243 asthma-related treatment periods were analysed. The monthly variation in the number of such periods showed a peak in January (18.2% above the mean number of monthly deaths in the study period) and a trough in July (26.1% below the mean). Of the 7,622 hospitalized asthmatics who died during the period examined here, 1,274 died of obstructive pulmonary diseases, with asthma as the primary cause in 489 cases. The majority of the deaths were caused by cardiovascular diseases. Mortality was highest in January (+14.7%) and lowest in August (-12.3%). The similarity in the seasonal variation observed between the treatment periods and deaths recorded for adult asthmatics may be taken to indicate a genuine need for treatment.
Birth characteristics and asthma symptoms in young adults: results from a population-based cohort study in Norway
Authors: Svanes C , Omenaas E , Heuch JM , Irgens LM , Gulsvik A
Published: November 2002

There is evidence that the origin of obstructive lung disease may be traced back to foetal life. The associations between birth characteristics and asthma symptoms were studied in a random population sample of young Norwegian adults. Respiratory symptoms were recorded in a population-based questionnaire survey. The records of all subjects aged 20-24 yrs were linked with the Medical Birth Registry of Norway. Of 868 subjects born in Norway, there were 690 (79%) responders. The associations between asthma symptoms and birth characteristics were analysed by logistic regression, adjusted for possible confounding factors. Asthma symptoms in young adults were inversely associated with birth weight (odds ratio (OR)wheeze=0.82; 95% confidence interval (CI)=0.69-0.96x500 g increase in birth weight(-1))), and after adjustment for gestational age, birth length, parity and maternal age (ORwheeze=0.69; 95% CI=0.50-0.95x500 g increase in birth weight(-1)). The association did not vary according to adult smoking habits or atopic status and remained when premature and low weight births were excluded (ORwheeze=0.73; 95% CI=0.60-0.90x500 g increase in birth weight(-1)). The association was consistent for all asthma symptoms. Adjusted for birth weight, asthma symptoms were further associated with low gestational age, high birth length and low maternal age. In a random sample of young adults, asthma symptoms were strongly associated with low birth weight, an association driven by the full-term births within the normal birth weight range. The findings show that the risk for adult asthma is partly established early in life and suggest that poor intrauterine growth is involved in the aetiology of asthma.
Acute exposure to hair bleach causes airway hyperresponsiveness in a rabbit model
Authors: Mensing T , Marek W , Raulf-Heimsoth M , Baur X
Published: November 2002

Ammonium persulphate (APS) and hydrogen peroxide (H2O2) are used as oxidants in many industrial processes and are the main constituents of standard hair bleaching products. In a previous study, it was demonstrated that aerosols of APS induce alterations in airway responsiveness. The present study examined whether exposure for 4 h to a hair bleach composition (containing APS, potassium persulphate and H2O2) or H2O2 could induce airway hyperresponsiveness and/or an obstructive ventilation pattern in a rabbit model. Exposure to the aerosols altered neither baseline airway resistance, dynamic elastance, slope of inspiratory pressure generation nor arterial blood pressure and blood gas measurements. Similarly to APS, hair bleach aerosols containing > or =10.9 mg x m(-3) persulphate (ammonium and potassium salt) in air and > or =1.36 mg x m(-3) H2O2 in air caused airway hyperresponsiveness to acetylcholine after 4 h of exposure. Aerosolized H2O2 (> or =37 mg x m(-3) in air) did not influence airway responsiveness to acetylcholine. The results demonstrate that hair bleaching products containing persulphates dissolved in H2O2 cause airway hyperresponsiveness to acetylcholine in rabbits.
In vivo platelet and T-lymphocyte activities during pulmonary tuberculosis
Authors: Buyukasik Y , Soylu B , Soylu AR , Ozcebe OI , Canbakan S , Haznedaroglu IC , Kirazli S , Baser Y , Dundar SV
Published: November 2002

Platelets have been suggested to play a role in the inflammatory response, including defence against bacteria. The aims of this study were to determine in vivo platelet activity during the clinical course of pulmonary tuberculosis and to investigate whether or not there is a correlation between the magnitude of platelet activation and the extent of the pulmonary disease. T-lymphocyte activity was also analysed in the patients. Platelet factor-4 (PF4) and soluble interleukin-2 receptor-alpha (sIL-2Ralpha) concentrations were used as markers of platelet and T-lymphocyte activation, respectively. Twenty-five patients with pulmonary tuberculosis were studied. Fifteen healthy subjects served as a control group. The levels of both sIL-2Ralpha (3,000+/-1,948 pg x mL(-1)) and PF4 (103.1+/-6.7 IU x mL(-1)) were significantly higher in the patients with tuberculosis than in the control group (984+/-360 pg x mL(-1) and 78.2+/-23.9 IU x mL(-1), respectively) (Mann-Whitney U-test, p<0.001 for both comparisons). The plasma PF4 levels were found to be well correlated with the extent of pulmonary lesions on chest radiography (the Spearman's bivariate correlation analysis, r=0.65, p<0.001). However, sIL-2Ralpha concentrations did not correlate with the extent of disease. In conclusion, it has been suggested that platelet and T-lymphocyte activation occurs during pulmonary tuberculosis. The good correlation between platelet activation and the extent of pulmonary tuberculosis might be ascribed to a pathophysiological role of platelets in pulmonary tuberculosis.
Wartime migration and the incidence of tuberculosis in the Zagreb region, Croatia
Authors: Pavlovic M , Simic D , Krstic-Buric M , Corovic N , Zivkovic D , Rozman A , Peros-Golubicic T
Published: November 2002

The objective of the present study was to investigate the rate of decline in the incidence of tuberculosis (TB) in residents (1985-1994) and in refugees and displaced persons (1992-1994) during prewar and war periods (1985-1994) in the region of Zagreb, Croatia, and to examine a possible change in the trend of decline in the resident population. Data on the incidence of TB were obtained from the Epidemiology Department, Institute for Lung Diseases, Zagreb, Croatia. The sample comprised two groups of subjects: residents (800,000-1,000,000 inhabitants) and all refugees and displaced persons temporarily residing in the Zagreb region (78,000-95,000 persons). Data were analysed by stepwise logistic regression. The most significant predictors of the TB incidence rate were the square of the year and residence status. The rate of TB incidence in nonresidents was significantly higher than in residents. The decline in incidence in residents was significantly slower than in the nonresident group. The results did not indicate a potential change in the natural decline of the incidence of tuberculosis in the resident population during the study periods. The difference between the regression trends of the incidence of tuberculosis in residents and nonresidents was the result of various concomitant factors, including artefacts of the war.
Do radiographic features of acute infection influence management of lower respiratory tract infections in the community?
Authors: Simpson JC , Hulse P , Taylor PM , Woodhead M
Published: November 2002

Community-acquired lower respiratory tract infection (LRTI) is a common clinical problem, and a chest radiograph is the most common investigation. This study investigated why general practitioners (GPs) request radiographs and whether radiographic features of LRTI affect management. The 12 month study included GP-requested chest radiographs performed at the Manchester Royal Infirmary. The GPs of patients with radiographic evidence of LRTI were sent a questionnaire. Radiographs (n=2,538) were performed in patients aged >15 yrs. One hundred and eleven (4.4%) chest radiographs showed evidence of LRTI, and 97 (87%) were included in the analysis. Fifty-six (62%) had their radiograph requested at the second or third visit. Forty-five (58%) radiographs were performed to confirm infection. In 47 (48%) of cases the GP felt the radiograph had affected treatment. An effect on treatment was significantly more common in patients not receiving antibiotics prior to the radiograph. Twenty-nine (32%) of GPs felt a normal radiograph would have affected management, most often with respect to antibiotic prescriptions (17 (58%)). Where the radiologist's report suggested a repeat radiograph or hospital referral, this was significantly more likely to have occurred. The commonest reason for a radiograph in patients with suspected lower respiratory tract infection is to confirm the infection. In the opinion of the general practitioner the results of the radiograph do affect patient treatment. The wording of the radiologists report is associated with patient management.
Characterizing alterations in the pulmonary surfactant system in a rat model of Pseudomonas aeruginosa pneumonia
Authors: Vanderzwan J , McCaig L , Mehta S , Joseph M , Whitsett J , McCormack DG , Lewis JF
Published: November 2002

Bacterial pneumonia remains a significant cause of patient morbidity and mortality worldwide. Pulmonary surfactant serves to maintain homeostasis in the lung through the maintenance of alveolar stability and the regulation of the alveolar immune response. The purpose of this study was to characterize the lung injury and associated surfactant alterations in a rat model of acute Pseudomonas aeruginosa pneumonia. Pneumonia was induced in male Sprague-Dawley rats via intratracheal injection of 0.2 ml, phosphate-buffered saline (PBS) containing P. aeruginosa (6x10(8) colony-forming units x mL(-1)). Control animals received 0.2 mL sterile PBS. Twenty-four hours after inoculation, the pneumonia group (PN) exhibited clinical signs of pneumonia including deficits in gas exchange, leukopenia and elevated arterial lactate levels. Morphological assessment confirmed the presence of pneumonia with airspaces filled with polymorphonuclear cells. Lung homogenate analysis demonstrated evidence of bacterial colonization of pneumonic lung tissue. Lung compliance was also significantly lower in the PN group. Lung lavage analysis of PN rats revealed the pooled surfactant levels to be lower and the surfactant function reduced compared to control rats. Surfactant composition was also found to be altered in PN rats. These results demonstrate that in Pseudomonas aeruginosa pneumonia, the pulmonary surfactant system is both poorly functioning and reduced in quantity. These alterations may contribute to the lung dysfunction characteristic of this disorder.
Loss of immunoreactivity for RTI40, a type I cell-specific protein in the alveolar epithelium of rat lungs with bleomycin-induced fibrosis
Authors: Koslowski R , Dobbs LG , Wenzel KW , Schuh D , Muller M , Kasper M
Published: November 2002

After lung injury, the epithelial cells lining the alveolar surface in rat lung show an altered distribution of several membrane proteins. Pulmonary fibrosis was induced by intratracheal administration of bleomycin into the lung of rats and the distribution of RTI40, a recently detected alveolar epithelial type I cell antigen, was examined, as well as the relationship between RTI40 and a type I cell-specific antigen recognized by the monoclonal antibody MEP-1 and the type I cell-binding lectin Bauhinia purpurea in serial sections and double stainings. Loss of RTI40 protein was observed in fibrotic lungs, particularly in areas with obliteration of alveoli. Pre-embedding immunoelectron microscopy confirmed this observation by detection of RTI40 protein in the alveolar lumen. Western blot analysis revealed elevated levels of RTI40 in the bronchoalveolar fluid of bleomycin-treated rats with a maximum at day 7 after treatment. Twenty-eight days after bleomycin application, the bronchoalveolar fluid contained three times the amount of RTI40 x mg protein(-1) of control lungs, as determined by semiquantitative dot blot. These results suggest RTI40 as a tool for the evaluation of alveolar epithelial type I cell behaviour during re-epithelialization processes.
Heterogeneous point mutations of the p53 gene in pulmonary fibrosis
Authors: Hojo S , Fujita J , Yamadori I , Kamei T , Yoshinouchi T , Ohtsuki Y , Okada H , Bandoh S , Yamaji Y , Takahara J , Fukui T , Kinoshita M
Published: November 2002

Lung cancer is a frequent complication in pulmonary fibrosis. Overexpression of p53 proteins has been demonstrated by immunostaining in bronchoepithelial cells in patients with idiopathic pulmonary fibrosis. However, it is still unclear whether this overexpressed p53 protein is wild-type or mutant. It was hypothesized that pulmonary fibrosis may be a precancerous lesion with deoxyribonucleic acid point mutations in bronchoepithelial cells. Mutations of the p53 gene were tested for by fluorescence-based single-strand conformation polymorphism (FSSCP), cloning-sequencing and immunostaining techniques. Out of 10 tissue samples that demonstrated overexpression of p53 protein by immunostaining, nine (90%) exhibited point mutations and eight (80%) exhibited heterogeneous point mutations of the p53 gene. The mutations found in pulmonary fibrosis were scattered throughout the central part of the p53 gene, and both guanine (G):cytosine (C) to adenine (A):thymine (T) and A:T to G:C transitions were frequently observed. In conclusion, frequent heterogeneous point mutations of the p53 gene were detected in pulmonary fibrosis. These mutations may have resulted from several types of deoxyribonucleic acid damage that occurred in bronchoepithelial cells and this may explain previous findings of a very high incidence of lung cancer complicating pulmonary fibrosis.
Cyclophosphamide pulse therapy in idiopathic pulmonary fibrosis
Authors: Kolb M , Kirschner J , Riedel W , Wirtz H , Schmidt M
Published: November 2002

Idiopathic pulmonary fibrosis (IPF) is a progressive disorder with poor prognosis. Response to treatment is infrequent and the use of immunosuppressive agents other than corticosteroids is the subject of ongoing discussion because of uncertain efficacy and side-effects. To determine the efficacy and safety of cyclophosphamide pulse therapy in IPF, this study retrospectively analysed 18 patients with progressive IPF who were treated with intermittent i.v. cyclophosphamide (1-13 g x month(-1)) and additional oral prednisolone for 1 yr. Static lung volumes, arterial oxygen tension (Pa,O2) at rest, clinical symptoms and potential treatment-related side-effects were recorded. Cyclophosphamide had to be stopped in one patient, owing to repeated pulmonary infection; 11 patients were responders (five improving, six stabilizing) and six patients deteriorated. The change in vital capacity (VC) of responders was +6.7+/-18.0% (mean +/-SD), compared with -20.6+/-18.2% in nonresponders (p=0.008). Pa,O2 remained constant in responders (+0.13+/-0.88 kPa (+1.0+/-6.6 mmHg)), while it decreased in nonresponders (-2.08+/-1.92 kPa (-15.6+/-14.4 mmHg, p=0.008)). Additional prednisolone was reduced by 19.1+/-13.4 mg in responders, compared with 6.7+/-16.3 mg in nonresponders (p=0.02). VC at initiation of therapy was higher in responders (60.2+/-10.2 versus 40.3+/-12.9% predicted; p=0.004). No side-effects occurred, other than respiratory tract infection. These data demonstrate that intravenous cyclophosphamide pulse therapy may be a favourable regimen for certain patients with progressive idiopathic pulmonary fibrosis. Patients with a vital capacity of more than 50% predicted and a shorter duration of disease may benefit most.
Cytology of bronchial biopsy rinse fluid to improve the diagnostic yield for lung cancer
Authors: Rosell A , Monso E , Lores L , Vila X , Llatjos M , Ruiz J , Morera J
Published: November 2002

Sampling techniques are combined during bronchoscopy to increase the diagnostic yield for endobronchial malignant tumours. Bronchial biopsy provides the definitive histological diagnosis in most cases, but accompanying cytological procedures such as washing, brushing, needle aspiration or imprint cytology can increase diagnostic yield. In this prospective study, a different cytological technique, that could enhance the diagnostic yield of bronchoscopy without increasing its time or cost, was tested. Flexible bronchoscopy was performed in 93 patients suspected of having pulmonary neoplasms. Bronchial biopsies were initially placed in a balanced salt solution. When bronchoscopy was finished, all visible tissue fragments were removed and placed in formalin to undergo histopathological examination and the rinse fluid was sent for cytological examination. Washing was performed routinely but no cytological brushing was employed. Eighty-two patients had final diagnoses of malignant neoplasm. In four (4.8%) of these patients, the only positive result came from the cytological examination of the bronchial biopsy rinse fluid. No false-positive results were found. The agreement with the histological results was 81.8%. The addition of bronchial biopsy rinse-fluid examination increased the sensitivity of bronchoscopy from 65.8% to 70.7% (McNemar's p=0.009). The cytological study of bronchial biopsy rinse fluid offers reliable positive results in an additional 4.8% of cases, thus enhancing bronchoscopic diagnostic yield for malignant endobronchial tumours while neither prolonging the procedure nor increasing costs.
Talc-induced inflammation in the pleural cavity
Authors: van den Heuvel MM , Smit HJ , Barbierato SB , Havenith CE , Beelen RH , Postmus PE
Published: November 2002

Talc administration into the pleural cavity induces pleurodesis. To obtain further insight into the inflammatory process that causes pleurodesis, the cellular kinetics in the pleural space after the administration of talc was studied, along with its relation to chemokine concentrations in the pleural fluid. Thirteen consecutive patients with idiopathic spontaneous pneumothorax and eight patients with malignant pleural effusions received talc pleurodesis. The first group was treated with talc poudrage, whereas the second group was treated with talc slurry. Pleural fluids were isolated before talc administration as well as 3, 6, 24, 48 and 72 h afterwards. The talc induced a rapid polymorphonuclear neutrophil (PMN) influx followed by an accumulation of macrophages. In addition, increased production of interleukin (IL)-8 and monocyte chemotactic protein (MCP)-1 was observed. The talc-induced PMN influx reached its maximum after 3-24 h, and was related to the IL-8 concentration. In contrast, the MCP-1 was not related to the macrophage accumulation. Talc-induced inflammation in patients with idiopathic spontaneous pneumothorax and malignant pleural effusion is characterized by an influx of polymorphonuclear neutrophils related to interleukin-8, followed by an accumulation of monocytes.
Preoperative CYFRA 21-1 level as a prognostic indicator in resected nonsmall cell lung cancer
Authors: Niklinski J , Burzykowski T , Niklinska W , Laudanski J , Chyczewski L , Rapellino M , Furman M
Published: November 2002

Cytokeratin 19 is particularly abundant in carcinoma of the lung. The CYFRA 21-1 assay has recently been developed for detection of a cytokeratin 19 fragment in serum. In the current study, the prognostic information provided by the CYFRA 21-1 assay in operable nonsmall cell lung cancer (NSCLC) was analysed. Serum levels of CYFRA 21-1 were measured using an immunoradiometric assay (DiaSorin) in 94 patients with operable NSCLC. Survival and disease-free survival curves related to initial levels of this marker were estimated using the Kaplan-Meier method. Elevated preoperative CYFRA 21-1 levels were identified in 42% of patients with NSCLC. The number of patients with elevated levels of this marker increased with tumour node metastasis (TNM) stage (p=0.02). In univariate analysis elevated levels of CYFRA 21-1 were significantly associated with poor overall survival (p<0.001) and with disease-free survival (p<0.001). The results remained significant when the comparisons were adjusted, using the stratified log-rank test, for patient's TNM stage (p<0.001 for both overall and disease-free survival). Elevated preoperative levels of CYFRA 21-1 decreased the probability of survival or surviving without recurrence 15 months or more after the operation. This was confirmed by the results of the multivariate analysis. In conclusion, CYFRA 21-1 may be an independent prognostic parameter of survival and tumour relapse in nonsmall cell lung cancer and may be useful in identifying resected cancer patients at high risk for treatment failure.
Invasive exercise testing in the evaluation of patients at high-risk for lung resection
Authors: Ribas J , Diaz O , Barbera JA , Mateu M , Canalis E , Jover L , Roca J , Rodriguez-Roisin R
Published: November 2002

The aim of this study was to investigate whether invasive exercise testing with gas exchange and pulmonary haemodynamic measurements could contribute to the preoperative assessment of patients with lung cancer at a high-risk for lung resection. Sixty-five patients scheduled for thoracotomy (aged 66+/-8 yrs (mean+/-SD), 64 males, forced expiratory volume in one second (FEV1) 54+/-13% predicted) were studied prospectively. High risk was defined on the basis of predicted postpneumonectomy (PPN) FEV1 and/or carbon monoxide diffusing capacity of the lung (DL,CO) <40% pred. Arterial blood gas measurements were performed in all patients at rest and during exercise. In 46 patients, pulmonary haemodynamic measurements were also performed at rest and during exercise. Predicted postoperative (PPO) values for FEV1 and DL,CO were calculated according to quantitative lung scanning and the amount of resected parenchyma. There were four postoperative deaths (6.2% mortality rate) and postoperative cardiorespiratory complications developed in 31 (47.7%) patients. Patients with respiratory complications only differed from patients without or with minimal (arrhythmia) complications in FEV1,PPO. Peak O2 uptake and haemodynamic variables were similar in both groups. The four patients who died had a lower FEV1,PPO, a lower DL,CO,PPO and a greater decrease in arterial oxygen tension during exercise, compared with the remaining patients. In conclusion, the forced expiratory volume in one second, together with the extent of parenchymal resection and perfusion of the affected lung, are useful parameters to identify patients at greatest risk of postoperative complications among those at a high-risk for lung resection. In these patients, pulmonary haemodynamic measurements appear to have no discriminatory value, whereas gas exchange measurements during exercise may help to identify patients with higher mortality risk.
Variations in airways impedance during respiratory cycle derived from combined measurements of input and transfer impedances
Authors: Tomalak W , Peslin R , Duvivier C
Published: November 2002

Simultaneous measurement of input (Zin) and transfer impedances (Ztr) allows separation of airway and tissue properties at a single frequency, without making assumptions concerning the structure of the two compartments. This approach offers the possibility of studying the variation in airway impedance (Zaw) during the respiratory cycle. Zin and Ztr were measured at frequencies of 10, 20, 30 and 40 Hz in eight healthy subjects to study the variations in Zaw according to a modification of the Rohrer's equation: X=K1+K2(V'ao)-K3V, where V is volume and V'ao the flow at the airway opening. The results showed that Zaw could be modelled as a simple resistance-inertance pathway. Variations in airway resistance (Raw) with flow were greater during expiration than during inspiration with K2 values varying from 0.76-0.90 hPa x s2 x L(-2) during inspiration and 0.84-1.47 hPa x s2 x L(-2) during expiration, independently of frequency. Raw was negative volume dependent; it decreased more with increasing volume during inspiration than during expiration. Airways inertance calculated from the imaginary part of Zaw also underwent systematic variations during the respiratory cycle, but, in contrast to Raw, flow dependence was negative during both phases. In conclusion, the approach used in this study allows flow and volume dependencies of airways mechanical properties to be studied and can also provide indices of airway patency independently of flow, which is of great potential interest for studying variations in airway resistance during bronchomotor tests.
Effects of a standard hyperbaric oxygen treatment protocol on pulmonary function
Authors: Thorsen E , Aanderud L , Aasen TB
Published: November 2002

The prescription of hyperbaric oxygen (HBO) therapy for disorders not related to diving is increasing. Pulmonary oxygen toxicity is well known, but the effect of the cumulative oxygen exposure corresponding to a standard HBO treatment protocol has not been quantified before. Twenty patients (10 male) had 21 HBO treatments at a partial pressure of oxygen of 240 kPa for 90 min daily. None had any previous lung disease and all had normal chest radiography and lung function at the start of the study. Dynamic lung volumes, forced expiratory flows and the transfer factor of the lung for carbon monoxide (TL,CO) were measured before the HBO treatment, on days 7, 14 and 21 during treatment and then 3-4 weeks after treatment. Four patients (one male) reported nonproductive coughing during the last week of treatment. There was a progressive reduction in forced expiratory volume in one second (FEV1) (p<0.001), mean forced mid-expiratory flow rate (FEF25-75%) (p<0.001) and forced expiratory flows at 50 and 75% of forced vital capacity (FVC) expired during HBO treatment. The reduction in FEV1 on day 21 was 4.4+/-1.7% and in FEF25-75% 10.3+/-6.1%. Four weeks after treatment there was a partial normalization. There were no changes in FVC or peak expiratory flow (PEF). TL,CO was slightly reduced on day 21 of treatment only (p<0.01) and fully normalized 1 month later. A reduction in small airways conductance is consistent with other studies where total oxygen exposures have been below the limit causing toxic pulmonary effects traditionally measured as a reduction in vital capacity. This effect is not considered to be of any clinical significance for patients treated with hyperbaric oxygen unless repeated treatment series are to be given.
Plasma coagulation profiles in patients with severe primary pulmonary hypertension
Authors: Hoeper MM , Sosada M , Fabel H
Published: November 2002

Patients with primary pulmonary hypertension (PPH) benefit from treatment with anticoagulants, and histological findings suggest that in situ thrombosis of pulmonary vessels contributes to the pathogenesis of this disease. The mechanisms that cause a hypercoagulable state in the pulmonary vascular bed have not been fully investigated. This study compared plasminogen plasma activity, protein C and protein S plasma activities, fibrinogen and fibrin degradation products (FGDP and FBDP, respectively), von Willebrand factor antigen (vWF-Ag), prothrombin fragment F1.2, thrombin-antithrombin complexes (TAT), tissue plasminogen activator (tPA), and plasminogen activator inhibitor (PAI) in 16 patients with PPH and in 16 healthy volunteers. In a subset of the PPH patients, these variables were also compared in simultaneously-obtained mixed-venous and arterial blood samples. Proteins C and S, FGDP, FBDP, and plasminogen levels as well as plasma concentrations of prothrombin fragment F1.2 and TAT were normal in the 16 patients with PPH. In contrast, the plasma activity of PAI was significantly elevated (p<0.0001). Arterial PAI levels were considerably higher than mixed venous PAI levels (p=0.0018), which may reflect intrapulmonary production. Furthermore, vWF-Ag levels were significantly elevated (p<0.0001), but there was no significant difference between mixed-venous and arterial blood. These data, on the whole, do not suggest increased thrombin activity in patients with primary pulmonary hypertension. However, the markedly elevated levels of plasminogen activator inhibitor as well as its transpulmonary gradient may provide a clue to locally impaired fibrinolysis in the pulmonary vascular bed.
The influence of personal tobacco smoking on the clinical practice of Italian chest physicians
Authors: Nardini S , Bertoletti R , Rastelli V , Donner CF
Published: November 2002

Tobacco smoking (TS) is a major cause of lung diseases. This study aimed to determine: 1) the prevalence of TS among chest physicians; 2) the influence of the personal smoking habit on clinical practice; and 3) what training about tobacco-related issues (TI) doctors received in medical school. A total of 983 attendees at the National Meeting of the Italian National Thoracic Society (AIPO) received a questionnaire about TI, which also contained the Fagerstroem Tolerance Questionnaire, and 605 (61.5%) answered. An independent assessment of the prevalence of smokers was carried out to minimize the bias of self-selection. The numbers of smokers was 151 (25%), never-smokers 246 (40.7%) and exsmokers 208 (34.4%). Smoking chest physicians underestimate the health hazards of smoking (p<0.001) and disregard their educational role (p=0.005) more than nonsmoking chest physicians. Compliance with smoking restrictions inside hospitals is frequently poor (30.1% smoke in clinics). In 33.1% of smokers a high nicotine addiction was found, which influenced their behaviour in hospital but not their ability to cope with tobacco-related problems. This ability was generally low: 39.1% of responders reported no training about TI. Smoking is frequent among Italian chest physicians, who are poorly trained about the health effects of tobacco smoking and are poorly skilled in treating smokers.
Regulation of airway neurogenic inflammation by neutral endopeptidase
Authors: Di Maria GU , Bellofiore S , Geppetti P
Published: November 2002

Airway neurogenic inflammation is caused by tachykinins released from peripheral nerve endings of sensory neurons within the airways, and is characterized by plasma protein extravasation, airway smooth muscle contraction and increased secretion of mucus. Tachykinins are degraded and inactivated by neutral endopeptidase (NEP), a membrane-bound metallopeptidase, which is located mainly at the surface of airway epithelial cells, but is also present in airway smooth muscle cells, submucosal gland cells and fibroblasts. The key role of NEP in limiting and regulating the neurogenic inflammation provoked by different stimuli has been demonstrated in a large series of studies published in recent years. It has also been shown that a variety of factors, which are relevant for airway diseases, including viral infections, allergen exposure, inhalation of cigarette smoke and other respiratory irritants, is able to reduce NEP activity, thus enhancing the effects of tachykinins within the airways. On the basis of these observations, the reduction of neutral endopeptidase activity may be regarded as a factor that switches neurogenic airway responses from their physiological and protective functions to a detrimental role that increases and perpetuates airway inflammation. However, further studies are needed to assess the role of neutral endopeptidase down regulation in the pathogenesis of asthma and other inflammatory airway diseases.
Immunogenetic basis of environmental lung disease: lessons from the berylliosis model
Authors: Saltini C , Amicosante M , Franchi A , Lombardi G , Richeldi L
Published: November 2002

The role of genetic factors has been hypothesized in the pathogenesis of a number of chronic inflammatory lung diseases. The genes of the major histocompatibility complex (MHC) locus on human chromosome 6 have been identified as important determinants in diseases caused both by inorganic and organic compounds such as beryllium, gold, acid anhydrides, isocyanates and grass pollens. Since many environmental factors are the determinants of the immunopathogenesis of asthma, pulmonary granulomatous disorders, hypersensitivity pneumonitis and fibrotic lung disorders, an understanding of the interaction between environmental factors is crucial to epidemiology, prevention and treatment of these disorders. Berylliosis is an environmental chronic inflammatory disorder of the lung caused by inhalation of beryllium dusts. A human leukocyte antigen class II marker (HLA-DP Glu69) has been found to be strongly associated with the disease. In in vitro studies, the gene has been shown to play a direct role in the immunopathogenesis of the disease. In human studies, the gene has been shown to confer increased susceptibility to beryllium in exposed workers, thus suggesting that HLA gene markers may be used as epidemiological probes to identify population groups at higher risk of environmental lung diseases, to identify environmental levels of lung immunotoxicants that would be safe for the entire population and to prevent disease risk associated with occupation, manufactured products and the environment. Studies on the associations between human leukocyte antigens and chronic inflammatory lung disorders are reviewed in the context of the berylliosis model.
False-positive diagnosis of pulmonary hypertension by Doppler echocardiography
Authors: Vachiery JL , Brimioulle S , Crasset V , Naeije R
Published: November 2002

A 37-yr-old female presented with a history of several months of exertional dyspnoea. A diagnosis of primary pulmonary hypertension was suspected on the basis of a negative extensive cardiorespiratory work-up with a systolic pulmonary artery pressure of 41-46 mmHg calculated from repeated measurement of the maximum velocity of tricuspid regurgitation jets at 2.8-3 m x s(-1) by continuous-wave Doppler echocardiography. However, a right heart catheterization with a high-fidelity transducer-tipped catheter revealed pulmonary artery pressures of 22/8 mmHg at rest, which remained within normal limits at exercise. This case indicates a possible misleading overestimation of pulmonary artery pressures from Doppler echocardiographic studies of tricuspid regurgitation.
Successful combined lung and kidney transplantation for pulmonary lymphangioleiomyomatosis and renal angiolipomas
Authors: de Perrot M , Licker M , Robert J , Nicod L , Spiliopoulos A
Published: November 2002

Pulmonary lymphangioleiomyomatosis (LAM) and renal angiolipomas are rare but distinct clinical entities that share similar morphological features. Lung transplantation is considered as a valuable therapeutic modality in patients with end-stage pulmonary LAM. However, in some patients, renal complications due to bleeding angiomyolipomas and cyclosporin-induced nephropathy have become newly identified problems. This study reports the first case of combined lung and kidney transplantation for pulmonary lymphangioleiomyomatosis and renal angiolipomas. Two years after transplantation, renal and pulmonary function have remained stable and the patient has resumed a normal daily life, including a full-time professional activity.
Central sleep apnoea in Arnold-Chiari malformation: evidence of pathophysiological heterogeneity
Authors: Rabec C , Laurent G , Baudouin N , Merati M , Massin F , Foucher P , Brondel L , Reybet-Degat O
Published: November 2002

We report on the case of two young patients with type I Arnold-Chiari malformation (ACM), as revealed by a central sleep apnoea (CSA) syndrome without any other neurological defect. Case 1 was a 14-yr-old male patient, who developed severe alveolar hypoventilation and needed long-term mechanical ventilation via a tracheostomy. Case 2 was a 39-yr-old male patient, who developed features suggestive of sleep apnoea and responded to nasal continuous positive airway pressure ventilation despite the central type of apnoeas. These two cases illustrate the different pathophysiological mechanisms involved in CSA, namely a blunted chemical drive (in hypercapnic patients) and an increased chemical drive, which destabilizes the breathing pattern during sleep (in normo/hypocapnic patients). Central sleep apnoea can be the initial manifestation of Arnold-Chiari malformation and can lead to a life-threatening condition.
Cognitive linguistics
Authors: Eynon Terri
Published: November 2002

Cognitive linguistics is a new development in one of the basic sciences of psychiatry. It takes a novel approach to metaphor that is having an impact on philosophy and cognitive neuroscience, offering a perspective on questions about the development of language and the embodiment of mind that may have an impact on psychiatry. Likewise, our expertise in mental pathology may be required for further development in cognitive linguistics (Lakoff, 1997).
Attempted suicide in South Asian women
Authors: Bhugra Dinesh , Desai Manisha
Published: November 2002

Humans have attempted and successfully committed suicide since time immemorial. The reasons for killing or harming oneself vary with cultures and societies and in urban or rural settings.
Treating people with learning disabilities after physical or sexual abuse
Authors: Sinason Valerie
Published: November 2002

It is a sign of the progress we have made in the field of learning disability that it is possible to consider three previously taboo subjects in one paper. Before 1979, there was no published English clinical or theoretical paper which looked at either talking treatments for people with learning disabilities, treatment for those who survived physical and sexual abuse or, specifically, talking treatment for survivors of abuse who also have learning disabilities. Such steps forward bring hope for the future, but also pain concerning the past. How often have emotional and behavioural communications of betrayal and violation been ascribed to ‘disability’ and not been properly considered because there was no social intellectual context to help us to consider that there might be a reason for them? This also illustrates the need for continuing professional humility and toleration of uncertainty. What painful experiences and communications of our patients are we missing today because of internal and external taboos? How will we feel when we become aware of them in another 10 or 20 years' time?
Therapeutic uses of security: mapping forensic mental health services by stratifying risk
Authors: Kennedy H. G.
Published: November 2002

The syllabus for higher training in forensic psychiatry requires knowledge of the therapeutic uses of security, although there are no references to this in standard texts. Similarly, the process of mapping a mental health service is an essential first step in planning, audit and needs assessment. All mental health services, not just forensic services, are organised to stratify patients according to the risk they present so that they can be cared for in an environment that is safe but imposes the minimum necessary restrictions and intrusions. Forensic mental health services differ from other mental health services mainly by including subsystems which are at higher levels of security than those necessary in local services. Although they have a general orientation towards risk awareness and risk management, they remain integral parts of the mental health services for the populations they serve.
Multi-sensory therapy in psychiatric care
Authors: Baillon Sarah , van Diepen Erik , Prettyman Richard
Published: November 2002

Multi-sensory therapy is an activity which usually takes place in a dedicated room where patients experience a range of unpatterned visual, auditory, olfactory and tactile stimuli (Baker et al, 1997). These rooms are designed to create a feeling of comfort and safety, where the individual can relax, explore and enjoy the surroundings (Fig 1.).
Seismic Hazard Assessment: Simultaneous Effect of Earthquakes at Close and Distant Sites
Authors: Leonard Gideon , Steinberg David M.
Published: November 2002

A modified version of seismic hazard assessment, directed toward planning of emergency relief efforts, is proposed. The method begins with a probabilistic hazard assessment to determine a reference peak ground acceleration (PGA) at a near site, rather than using a reference earthquake of a given magnitude. The reference PGA then serves as a basis for a probabilistic assessment of PGA at more distant sites. The ideas are illustrated by studying seismic hazard for Northern Israel from earthquakes on the northern section of the Dead Sea Rift (DSR). The reference PGA at a site 10 km from the DSR is taken to be 0.3 g, which has a return period estimated to be 320 years. Given an event with PGA of 0.3 g at 10 km, the subsequent analysis for distant sites shows that there is less than a 31% probability of PGA above 0.1 g at 30 km and an 8% probability that the PGA at 50 km will exceed 0.1 g.
Seismic Performance of a Base-Isolated Demonstration Building
Authors: Taniwangsa Wendy
Published: November 2002

This paper presents the dynamic analyses and seismic performance of a base-isolated demonstration building (BIDB). This building was designed and built in Indonesia in accordance with the Indonesian Seismic Code (ISC) and the Uniform Building Code (UBC) provisions for isolated buildings. The building is a four-story reinforced concrete frame with masonry infill walls supported on 16 high damping natural rubber (HDNR) isolators attached to the superstructure using recessed connections. The building superstructure was modeled using both three-dimensional (3-D) and two-dimensional (2-D) frame models. The isolators were modeled as a combination of linear springs and viscous dampers, whose properties were determined from testing. Time-history (TH) and response-spectra (RS) analyses performed on this building demonstrated that this newly developed isolation system, designed specially for low axial pressure applications, was effective in protecting the building superstructure from earthquake forces for all seismic risk levels being considered. The total isolator displacement obtained using the TH and RS approaches is also compared and discussed.
Toward an Ideal Synthesis of Oligonucleotides: Development of a Novel Phosphoramidite Method with High Capability
Authors: Hayakawa Yoshihiro
Published: November 2002

Several novel methods for reliably carrying out the oligonucleotide synthesis via the phosphoramidite strategy have been developed. The first is the method using allyloxycarbonyl and allyl groups for the protection of nucleoside bases and internucleotide linkages, respectively. These protectors can be cleanly removed under almost neutral conditions with a mixture of an organic Pd(0) complex such as Pd[P(C6H5)3]4 or Pd2[(C6H5CH=CH)2CO]3·CHCl3, and P(C6H5)3 in the presence of a nucleophile such as butylammonium formate, diethylammonium hydrogencarbonate, diethylammonium carbonate, or dimedone. A method for the facile oxidation of nucleoside phosphites to phosphates has been developed; this is performed under non-aqueous and non-basic conditions using 2-butanone peroxide in dichloromethane, t-butyl hydroperoxide in toluene, or bis(trimethylsilyl) peroxide in dichloromethane. The combined use of the N-allyloxycarbonyl/P–O-allyl-protected method and anhydrous/non-basic oxidation is extremely useful for the synthesis of nucleotide derivatives sensitive to moisture and/or bases, producing them in higher yield and at a greater level of purity than the existing methods using acyl or aroyl and cyanoethyl groups for the protection of nucleoside bases and internucleotide linkages, respectively, and iodine in aqueous pyridine for the oxidation. Further, acid/azole complexes serving as highly useful activators of phosphoramidites have been invented. The reagents include imidazolium triflate, N-(phenyl)imidazolium triflate, benzimidazolium triflate, and N-(methyl)benzimidazolium triflate, which allow higher-yield synthesis of oligonucleotides than conventionally employed 1H-tetrazole and related reagents. For example, synthesis of oligoribonucleotides via the allyloxycarbonyl/allyl-protected strategy has been carried out more efficiently using N-(phenyl)imidazolium triflate as a promoter than 5-(ethylthio)-1H-tetrazole, which has been found to be the most effective promoter among those currently available for oligoribonucleotide synthesis. Further, imidazolium triflate has opened the door to the extremely convenient and efficient synthesis of oligodeoxyribonucleotides without nucleoside-base protection. This method is obviously advantageous over N-protected methods because it eliminates tedious operations and the use of superfluous reagents required for the introduction and removal of the N-protecting group; risks of decomposition and loss of product by protection and deprotection are also avoided. Facile liquid-phase preparation of short oligomers has also been developed; this is successfully accomplished using stoichiometric amounts of building blocks by the aid of an equimolar amount of azolium reagent or a catalytic amount of 5-(p-nitrophenyl)-1H-tetrazole. These two methods are beneficial from an economical point of view, particularly in large-scale synthesis.