bluuebunny/crossref_metadata_2025 huggingface dataset:
Leukocyte extravasation: chemokine transport and presentation by the endothelium
Authors: Middleton Jim , Patterson Angela M. , Gardner Lucy , Schmutz Caroline , Ashton Brian A.
Published: November 2002

At sites of inflammation and in normal immune surveillance, chemokines direct leukocyte migration across the endothelium. Many cell types that are extravascular can produce chemokines, and for these mediators to directly elicit leukocyte migration from the blood, they would need to reach the luminal surface of the endothelium. This article reviews the evidence that endothelial cells are active in transcytosing chemokines to their luminal surfaces, where they are presented to leukocytes. The endothelial binding sites that transport and present chemokines include glycosaminoglycans (GAGs) and possibly the Duffy antigen/receptor for chemokines (DARC). The binding residues on chemokines that interact with GAGs are discussed, as are the carbohydrate structures on GAGs that bind these cytokines. The expression of particular GAG structures by endothelial cells may lend selectivity to the type of chemokine presented in a given tissue, thereby contributing to selective leukocyte recruitment. At the luminal surface of the endothelium, chemokines are preferentially presented to blood leukocytes on the tips of microvillous processes. Similarly, certain adhesion molecules and chemokine receptors are also preferentially distributed on leukocyte and endothelial microvilli, and evidence suggests an important role for these structures in creating the necessary surface topography for leukocyte migration. Finally, the mechanisms of chemokine transcytosis and presentation by endothelial cells are incorporated into the current model of chemokine-driven leukocyte extravasation.
BCL-2 expression in Hodgkin and Reed-Sternberg cells of classical Hodgkin disease predicts a poorer prognosis in patients treated with ABVD or equivalent regimens
Authors: Rassidakis George Z. , Medeiros L. Jeffrey , Vassilakopoulos Theodoros P. , Viviani Simonetta , Bonfante Valeria , Nadali Gianpaolo , Herling Marco , Angelopoulou Maria K. , Giardini Roberto , Chilosi Marco , Kittas Christos , McDonnell Timothy J. , Bonadonna Gianni , Gianni Alessandro M. , Pizzolo Giovanni , Pangalis Gerassimos A. , Cabanillas Fernando , Sarris Andreas H.
Published: November 2002

To determine the clinical significance of BCL-2 expression in Hodgkin-Reed-Sternberg (HRS) cells of classical Hodgkin disease (cHD), we correlated its expression with presenting clinical and laboratory features and failure-free survival (FFS). Eligible patients were untreated and negative for HIV-1; they had biopsy-proven cHD. BCL-2 expression was determined immunohistochemically in available pretreatment tissue biopsy specimens without knowledge of clinical outcome. Tumors were considered positive if any HRS cells expressed BCL-2. We identified 707 patients with cHD, whose median age was 30 years; 54% were men. HRS cells expressed BCL-2 in 359 (65%) of 551 nodular sclerosis, 67 (47%) of 143 mixed cellularity, and all 5 lymphocyte depletion. For all patients, the 5-year FFS was 74% versus 84% for tumors with versus without BCL-2 expression (P = .0016, by log-rank test). For the 412 patients treated with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) or equivalent regimens, the 5-year FFS for tumors with versus without BCL-2 expression was 74% versus 88% (P = .001, by log-rank test); for the 233 patients with Ann Arbor stage I or II, FFS was 84% versus 92% (P = .04, by log-rank test); and for the 179 patients with Ann Arbor stage III or IV, FFS was 62% versus 81% (P = .006, by log-rank test). Multivariate analysis confirmed that BCL-2 expression is independently associated with inferior FFS along with age 45 or older, Ann Arbor stage IV, low serum albumin and high serum lactate dehydrogenase levels. We conclude that BCL-2 is frequently expressed by HRS cells in cHD and is associated with inferior FFS in patients treated with ABVD or equivalent regimens.
High prevalence of bronchial hyperresponsiveness and asthma in ice hockey players
Authors: Leuppi JD , Kuhn M , Comminot C , Reinhart WH
Published: November 2002

The prevalence of asthma was studied in a ice hockey team compared with both a floor ball team and the Swiss population. Lung function, bronchial hyperresponsiveness to methacholine, asthma symptoms and exercise-induced asthma were measured in a cross-sectional prospective study. A positive response to the methacholine bronchial provocation test was found in 34.6% of the ice hockey players and 20.8% of the floor ball players (Swiss population 16.4%). The provocative dose causing a 20% fall in the forced expiratory volume in one second (PD20) was significantly lower in ice hockey players than in floor ball players, but there was no significant difference in the dose-response slopes between the two groups. Asthma was diagnosed in 19.2% of the ice hockey players and in 4.2% of the floor ball players (Swiss population 6.8%), whereas exercise-induced asthma was found in 11.5% of the ice hockey players and in 4.2% of the floor ball players. In conclusion, asthma and bronchial hyperresponsiveness seemed to be more common in ice hockey players than in floor ball players and in the Swiss population. Strenuous exercise at lower temperatures may be a risk factor for the higher prevalence of asthma and bronchial hyperresponsiveness, as well as the increased severity of bronchial hyperresponsiveness, particularly in ice hockey players.
Are International Asthma Guidelines effective for low-income Brazilian children with asthma?
Authors: Cabral AL , Carvalho WA , Chinen M , Barbiroto RM , Boueri FM , Martins MA
Published: November 2002

The present study was designed to evaluate the effectiveness of International Asthma Guidelines in low-income asthmatic children in the city of Sao Paulo, Brazil. Fifty children with moderate or severe asthma were evaluated. Patients were evaluated before and after a 1 yr follow-up period using a pre- and post-education design with patients acting as their own controls. Parents were interviewed before and 1 yr after the programme. Most of the children were receiving inadequate medical care from their primary physicians, based mainly on bronchodilators. After the educational programme combined with a medical treatment based mainly on inhaled steroids, there was a decrease in emergency room visits and no need for hospital admissions. There was also a significant decrease in asthma severity and impairment scores (p<.0001). The combination of good medical care and an educational programme can reduce the symptoms of asthma and significantly increase the quality of life, as well as decreasing the costs of asthma treatment. We conclude that by applying the International Asthma Guidelines substantial success was achieved, resulting in moving the patients from crises-orientated management into a chronic care and preventive management mode.
Asthma and respiratory symptoms in urban and rural Saudi Arabia
Authors: Hijazi N , Abalkhail B , Seaton A
Published: November 2002

The aim of this study was to contrast the prevalence of allergic symptoms in children living in urban and rural areas of Saudi Arabia and to investigate factors associated with any differences found. A cross-sectional questionnaire survey was conducted of a social class-stratified sample of 1,020 urban and 424 rural 12 yr old children, recording symptoms of current and past allergic disease and doctors' diagnoses, together with nationality and the fathers' educational level and occupations. A significantly greater prevalence of allergic symptoms was found in urban than in rural children and in Saudi than in non-Saudi Arab children. Males were more likely to have some respiratory symptoms and females had more eye and skin symptoms. Educational level and occupation of the father did not influence the likelihood of having symptoms. Logistic regression analyses showed that urban residence and Saudi nationality were the two main risk factors associated with asthmatic symptoms. There is likely to have been a recent increase in the prevalence of allergic disease in Saudi children associated with increased affluence, which has not affected non-Saudi migrants moving into the same environment to the same extent. This is consistent with the hypothesis that the environment, possibly through changes in lifestyle and patterns of infection, influences the expression of allergic disease.
Effects of cromolyn and nedocromil on ion currents in canine tracheal smooth muscle
Authors: Janssen LJ , Wattie J , Betti PA
Published: November 2002

Cromolyn and nedocromil are often used in the treatment of asthma. Recently, these agents have been shown to block Cl- currents and/or Ca2+ currents in a variety of cell preparations. Ca2+ and Cl- currents play central roles in excitation-contraction coupling in airway smooth muscle. This study therefore aimed to investigate the effects of these agents on membrane currents, elevations of [Ca2+] and contractions evoked by depolarization and/or acetylcholine in airway smooth muscle. Patch-clamp, fura-2 fluorimetric and muscle-bath techniques were used to monitor ion currents, [Ca2+] and contractions, respectively, in canine tracheal smooth muscle in the presence and absence of the chromones. Cromolyn and nedocromil eliminated voltage-dependent Ca2+ currents, leading to a reduction in depolarization-evoked K+ currents. Both chromones had little or no effect on either acetylcholine-evoked release of internal Ca2+ or the subsequent contraction; however, cromolyn (but not nedocromil) at high concentrations suppressed Ca2+-dependent Cl- currents triggered by acetylcholine. In conclusion, cromolyn and nedocromil abolished voltage-dependent Ca2+ currents and cromolyn also suppressed Ca2+-dependent Cl- currents in airway smooth muscle; neither chromone greatly altered either the release of internally sequestered Ca2+ or the resultant contractions. Further investigation is needed to determine whether the local concentrations obtained by inhaled chromones within the airway wall allow these cellular effects to occur in patients in vivo.
Pituitary adenylate cyclase activating peptide regulates neurally mediated airway responses
Authors: Shigyo M , Aizawa H , Inoue H , Matsumoto K , Takata S , Hara N
Published: November 2002

To clarify the protective effects of pituitary adenylate cyclase activating peptide (PACAP) on airway narrowing, we examined the effects of PACAP on smooth muscle contraction and plasma extravasation in guinea-pig airways. Smooth muscle contraction evoked by electrical field stimulation (EFS) or exogenously applied acetylcholine (ACh) or substance P (SP) was measured before and after PACAP in vitro. The effect of PACAP on airway plasma extravasation was also measured in vivo. In trachea, PACAP (10(-9) - 10(-7) M) significantly suppressed smooth muscle contraction evoked by EFS without affecting ACh sensitivity, suggesting that PACAP inhibits cholinergic neuroeffector transmission. In the main bronchi, PACAP (10(-9) - 10(-8) M) significantly suppressed the contraction evoked by EFS without affecting SP sensitivity in the presence of atropine, suggesting that PACAP inhibits SP release from excitatory nonadrenergic noncholinergic (eNANC) nerves. In animals treated with atropine and propranolol, PACAP attenuated the increase in plasma extravasation induced by electrical vagus stimulation or by SP. These results suggest that pituitary adenylate cyclase activating peptide may play a role in modulation of airway responses through inhibition of cholinergic and noncholinergic mechanisms.
Pulmonary epithelioid haemangioendothelioma in 21 patients, including three with partial spontaneous regression
Authors: Kitaichi M , Nagai S , Nishimura K , Itoh H , Asamoto H , Izumi T , Dail DH
Published: November 2002

This investigation studied the general conditions and prognostic factors of pulmonary epithelioid haemangioendothelioma (PEH), which is a rare disease. Twenty-one patients were collected throughout Asia by a questionnaire. Age at the detection or onset of symptoms of PEH was 14-64 yrs (mean 44 yrs). Males were more likely to be detected by symptoms (4/8, 50%) than were females (1/13, 8%). Fifteen showed bilateral multiple nodular opacities. Partial spontaneous regression occurred in three asymptomatic patients (one male and two females, all with bilateral multiple nodular opacities) 5, 13 and 15 yrs after detection. Two of the three patients with pleural effusion died within 1 yr, while the 16 patients with no effusion were alive more than 1 yr later (p<0.05). Histologically, two patients with fibrinofibrous pleuritis and extrapleural proliferation of tumour cells died within 2 yrs, while only one of 14 patients lacking such manifestations died within the same period (p<0.05). All three patients without spindle tumour cells survived for 12 yrs after the diagnosis, while all four patients with such cells died during the same period (p<0.05). In conclusion, 21 patients with pulmonary epithelioid haemangioendothelioma were reported, of whom three demonstrated partial spontaneous regression, and adverse prognostic features were identified.
Aetiology and outcome of severe community-acquired pneumonia in Singapore
Authors: Tan YK , Khoo KL , Chin SP , Ong YY
Published: November 2002

The aim of this study was to determine the aetiology and outcome of severe community-acquired pneumonia, and to assess whether the existing guidelines for initial antimicrobial therapy are being applied. The records of 57 consecutive nonimmunocompromised patients admitted to the medical intensive care unit (ICU) between January 1989 and May 1993 with this diagnosis were reviewed. The microbiological data, chest radiographic changes and outcome were analysed. Nine (16%) of the 57 patients had pulmonary tuberculosis. When these patients were excluded from further analysis, a microbiological diagnosis was made in 41 (72%) cases. The most commonest pathogens were Burkholderia pseudomallei (n=10), Klebsiella spp. (n=5) and Staphylococcus aureus (n=5), Mycoplasma pneumoniae (n=4) and Streptococcus pneumoniae (n=2) were less common. This microbiological spectrum was quite different from that in the West, where the incidence of S. pneumoniae was higher. Also, when pulmonary tuberculosis was excluded, the mortality (67%) was much higher than that in other series. This was attributed to the high incidence of unrecognized B. pseudomallei infection, which is associated with a very high mortality in the region under study. In addition to applying published guidelines on severe community-acquired pneumonia, the endemicity of certain organisms such as Mycobacterium tuberculosis and Burkholderia pseudomallei in different geographical regions needs to be considered when choosing initial empirical antimicrobial therapy.
Pulmonary complications in patients with haematological malignancies treated at a respiratory ICU
Authors: Ewig S , Torres A , Riquelme R , El-Ebiary M , Rovira M , Carreras E , Rano A , Xaubet A
Published: November 2002

Patients with haematological malignancies developing severe pulmonary complications have a poor outcome, especially after bone-marrow transplantation (BMT). We studied the aetiology, the yield of different diagnostic tools, as well as the outcome and prognostic factors in the corresponding population admitted to our respiratory intensive care unit (RICU). Overall, 89 patients with haematological malignancies and pulmonary complications treated within a 10 yr period were included. The underlying malignancies were predominantly acute leukaemia and chronic myeloid leukaemia (66/89, 74%). Fifty-two of 89 (58%) patients were bone marrow recipients. An aetiological diagnosis could be obtained in 61/89 (69%) of cases. The aetiology was infectious in 37/89 (42%) and noninfectious in 24/89 (27%). Blood cultures and cytological examinations of bronchoalveolar lavage fluid were the diagnostic tools with the highest yield (13/43 (30%) and 13/45 (29%) positive results, respectively). Necropsy results were coincident with results obtained during the lifetime in 43% of cases with infectious and 60% with noninfectious aetiologies. Overall mortality was 70/89 (79%), and 47/52 (90%) in transplant recipients. The requirement of mechanical ventilation, BMT, and an interval <90 days of BMT prior to ICU admission were independent adverse prognostic factors. The outcome in this patient population was uniformly poor. It was worst in bone marrow recipients developing pulmonary complications <90 days after transplantation and requiring mechanical ventilation. Decisions about intensive care unit admission and mech-anical ventilation should seriously consider the dismal prognosis of these patients.
Posterior subcapsular cataracts, bruises and hoarseness in children with asthma receiving long-term treatment with inhaled budesonide
Authors: Agertoft L , Larsen FE , Pedersen S
Published: November 2002

We assessed the effect of long-term treatment with inhaled budesonide (BUD) on the occurrence of posterior subcapsular cataracts (PSC), bruises and hoarseness in children with asthma. Slit lamp examinations were performed in 157 asthmatic children treated with inhaled BUD at a mean daily dose of 504 microg (range 189-1,322 microg) for 3-6 yrs (mean 4.4 yrs). Measurements were compared with 111 age-matched children with asthma, who had never received treatment of exogenous corticosteroids (control group). The children were examined for bruises, their tendency to bruise and occurrence of voice changes. No incidents of PSC ascribable to BUD treatment were seen. One patient in the BUD group had been diagnosed with PSC before the study and this was still present. There were no statistically significant differences in number of bruises between the two groups (BUD=33, controls=3.2; p=0.70), area covered by bruises (BUD=10 cm2, controls=10.1 cm2; p=0.97), tendency to bruise (BUD=5/10, controls=5/10) or occurrence of hoarseness (BUD=20%, controls=21%; p=0.92). Furthermore, there was no correlation between the occurrence of bruises or tendency to bruise and duration of treatment, accumulated or current dose of BUD. A 3-6 yr treatment of children with inhaled budesonide at an average daily dose of about 500 microg is not associated with an increased occurrence of posterior subcapsular cataract, bruises, tendency to bruise, hoarseness or other noticeable voice changes.
Differences in airway wall compliance as a possible mechanism for wheezing disorders in infants
Authors: Frey U , Jackson AC , Silverman M
Published: November 2002

High-frequency input impedance measurements (Z(f)) provide useful noninvasive information on airway geometry and especially airway wall mechanics in the canine and human adult respiratory system. Using the high-speed interrupter technique (HIT), we have shown that it is possible to measure high-frequency Z(f) in infants up to 900 Hz, including antiresonant phenomena which are known to be related to wave propagation velocity. This implies that the first antiresonant frequency (far,1) is a function of airway wall compliance. Since, airway wall mechanics are particularly important for the flow limitation phenomena, we wondered whether we could find evidence that airway wall properties were important for the occurrence of flow limitation during incremental methacholine challenge in infants. We measured Z(f) from 32-900 Hz and maximal flow at functional residual capacity (V'maxFRC) by the rapid chest compression technique in 10 infants (aged 36-81 weeks) with wheezing disorders. far,1 increased significantly at very low doses of mch before any decline could be detected in V'maxFRC. We hypothesize that these changes in far,1 are determined by mch-induced decrease in airway wall compliance. High-speed interrupter technique in combination with rapid chest compression technique can be used to study developmental differences in airway function (particularly of airway wall properties) and their contribution to airway disease and response to bronchodilator therapy in infants.
Effects of flutter and PEP mask physiotherapy on symptoms and lung function in children with cystic fibrosis
Authors: van Winden CM , Visser A , Hop W , Sterk PJ , Beckers S , de Jongste JC
Published: November 2002

Recently, the flutter was introduced as a new device to improve sputum expectoration. Preliminary data suggested a significant improvement in expectoration and lung function during flutter treatment in patients with cystic fibrosis (CF). The aim of the present study was to compare the effects of the flutter and the positive expiratory pressure (PEP) mask on symptoms and lung function in children with CF. In a crossover randomized study 22 patients with CF (mean age 12 yrs, range 7-17 yrs) performed physiotherapy using either the flutter or the PEP mask twice a day during two treatment periods of 2 weeks, separated by a one week wash-out period, in a random sequence. Lung function parameters (peak expiratory flow, forced vital capacity (FVC), forced expiratory volume in one second, maximal midexpiratory flow, maximal expiratory flow at 25% of FVC, thoracic gas volume, total lung capacity, residual volume/total lung capacity, airway resistance and specific airway conductance) and changes in transcutaneous oxygen haemoglobin saturation were assessed before and after the first supervised session and at the end of each treatment period. Throughout the study peak flow was measured and symptoms were scored daily. No significant changes in any lung function parameter occurred after a single session or after 2 weeks of physiotherapy with either method. There was no difference in acceptability and subjective efficacy. In conclusion, any superiority of the flutter over the positive expiratory pressure mask technique for expectoration could not be confirmed during 2 weeks of daily treatment in children with cystic fibrosis. Both methods are well accepted by children and do not change lung function. Long-term comparison of both methods, including expectoration measurements, seems to be required for further evaluation of the potential success of physiotherapy in cystic fibrosis.
High-frequency respiratory input impedance measurements in infants assessed by the high speed interrupter technique
Authors: Frey U , Silverman M , Kraemer R , Jackson AC
Published: November 2002

High-frequency input impedance (Z(f)) measurements, including antiresonances, provide useful noninvasive information on airway geometry and especially airway wall mechanics in the canine and human adult respiratory system. A knowledge of airway wall mechanics would be particularly important in understanding flow limitation phenomena in infants. High-frequency Z(f) has not been measured in infants above 256 Hz, because the high impedance of the infantile respiratory system would be expected to result in low amplitudes of oscillatory flow at higher frequencies. The aim of this study was to develop a technique to measure high-frequency Z(f) in infants and to elucidate the nature of the antiresonance phenomena in the Z(f) spectrum in infants. Z(f) was measured from 32-900 Hz during rapid airflow interruption by the high-speed interrupter technique (HIT) in 18 infants (aged 24-149 weeks) with wheezing disorders. The HIT enables the excitement of higher flow amplitudes at high frequencies using a pseudostep forcing function. In all infants Z(f) showed a mean (SD) first antiresonance (far,1) of 172 (35) Hz (real part of Z(f) at far,1 (Z(f)re(far,1)): 4.9 (1.1) kPa x L(-1) x s) and in five infants a second antiresonance (far,2) of 564 (51) Hz (Z(f)re(far,2): 2.0 (0.7) kPa x L(-1) x s). The antiresonances were found to be related to wave propagation in the airways (acoustic antiresonances), because they increased by a factor of approximately 2 when He-O2 was inhaled. This implies that far,1 and its harmonics are a function of airway wall compliance. In conclusion, the first and second antiresonances may be helpful in understanding flow limitation in wheezing disorders in infants, because flow limitation is related not only to airway diameter but also to airway wall compliance.
Delivery of salbutamol to nonventilated preterm infants by metered-dose inhaler, jet nebulizer, and ultrasonic nebulizer
Authors: Fok TF , Lam K , Ng PC , Leung TF , So HK , Cheung KL , Wong W
Published: November 2002

To identify the most efficient device for the delivery of bronchodilator aerosol to nonventilated preterm infants with chronic lung disease, we compared the metered dose inhaler (MDI) used in conjunction with a non-valved spacer, an ultrasonic nebulizer with a small medication cup, and two jet nebulizers. The subjects were enrolled in two double-blind randomized crossover studies. In study A (n=10), each infant was given a nominal dose of 200 microg of salbutamol by a MDI (Ventolin) at 4 h intervals, and in random sequence via an Aerochamber (Neonatal Aerochamber) with its one-way valve removed, an ultrasonic nebulizer with a small cone-shaped medication cup (Siemens Electronics), and a jet nebulizer (Side-stream). Their functional residual capacity (FRC) and static respiratory system mechanics were measured before, and at 15, 30, 60, and 120 min after aerosol delivery. Study B (n=10) was carried out in an identical manner, but with a different jet nebulizer (Hudson). In both studies, administration of salbutamol aerosol via the MDI Aerochamber or ultrasonic nebulizer resulted in a significantly greater reduction in respiratory system resistance than via jet nebulizers. Furthermore, the use of MDI Aerochamber or ultrasonic nebulizer was associated with a greater degree of post-treatment tachycardia and improvement in FRC. The bronchodilating effect of salbutamol delivered via the ultrasonic nebulizer appeared to be slightly greater than that via the MDI-Aerochamber, receiving significance only in Study B. We conclude that both the metered-dose inhaler used with a nonvalved Aerochamber and the ultrasonic nebulizer with a small medication cup are both more efficient than the jet nebulizers in preterm infants.
Respiratory mechanics in ventilated COPD patients: forced oscillation versus occlusion techniques
Authors: Farre R , Ferrer M , Rotger M , Torres A , Navajas D
Published: November 2002

The respiratory mechanics of artificially ventilated chronic obstructive pulmonary disease (COPD) patients were investigated by means of the forced oscillation (FOT) and the end-inspiratory airway occlusion (AOT) techniques. FOT was applied to measure respiratory resistance (Rrs) and reactance (Xrs) from 0.25-16 Hz. Maximum (Rmax) and minimum (Rmin) resistances, static elastance (Est) and time constant (T) were computed by AOT. FOT and AOT data were interpreted with models featuring airway wall shunt, tissue viscoelasticity and parallel inhomogeneity. Rrs* and Xrs*, predicted from the AOT data, were computed and compared with Rrs and Xrs measured by FOT. Rrs and Xrs (hPa x s x L(-1)) decreased from 31.2+/-10.3 to 5.9+/-4.6 and increased from -20.3+/-7.1 to -8.0+/-4.4 from 0.25-16 Hz, respectively. Central resistance (Rc) and peripheral resistance (Rp) (in hPa x s x L(-1)), and shunt elastance (Esh) and tissue elastance (Et) (in hPa x L(-1)) were 4.4+/-5.4, 28.4+/-153, 723+/-393 and 31.8+/-10.1, respectively. Rmin, Rmax and Est were 18.4+/-5.9, 28.4+/-12.8 and 18.1+/-4.2 respectively, and T=0.76+/-0.25 s. The frequency dependence of predicted Rrs* and Xrs* differed markedly from that of measured Rrs and Xrs. The use of different models to interpret the measured data suggests that both airway and tissue properties determined the frequency dependence of respiratory resistance and respiratory reactance in ventilated chronic obstructive pulmonary disease patients at the investigated frequencies (0.25-16 Hz).
A French survey of 3,225 patients treated with CPAP for obstructive sleep apnoea: benefits, tolerance, compliance and quality of life
Authors: Meslier N , Lebrun T , Grillier-Lanoir V , Rolland N , Henderick C , Sailly JC , Racineux JL
Published: November 2002

The aim of this study was to investigate in a large population of patients with obstructive sleep apnoea and on long-term treatment with continuous positive airway pressure (CPAP) the patients' perception of symptomatic improvement, side-effects and quality of life. Questionnaires were mailed via local respiratory homecare associations to 5,339 French patients who had been treated at home for at least 6 months with CPAP machines and who continued their treatment. In total, 3,225 questionnaires were analysable. More than 80% of the responding patients reported that CPAP treatment had greatly improved their symptoms. Despite discomfort related to nasal problems and excess noise from the blower, the mean rate of use for the whole population was 6 h 36 min+/-2 h 15 min. The perceived health evaluated by the Nottingham Health Profile was good (mean score <50) for at least 75% of the patients in each dimension explored. The perceived health was significantly related to the improvement in symptoms, the overall satisfaction and the objective compliance. This retrospective study indicates that patients who continued continuous positive airway pressure treatment for more than 6 months felt a great improvement in their symptoms, were satisfied with the treatment and had a relatively good perception of their health.
Upper airway mucosa temperature in obstructive sleep apnoea/hypopnoea syndrome, nonapnoeic snorers and nonsnorers
Authors: Series F , Marc I
Published: November 2002

Upper airway (UA) inflammation (oedema and hyperaemia) is frequently observed in snorers and patients with sleep apnoea/hypopnoea patients. The temperature of different UA regions measured in 11 male nonsnorers, 13 nonapnoeic snorers and 10 untreated sleep apnoea/hypopnoea syndrome (SAHS) patients using infra-red video recording. Measurements were taken with the mouth open during tidal volume mouth breathing, and at the beginning and end of a 10 s end-inspiratory voluntary apnoea which followed either mouth or nasal breathing. Three measurements were obtained from the uvula and from each side of the posterior pharyngeal wall and two from each side of the soft palate. The different UA regions were characterized by their inspiratory temperature, the expiratory rewarming and the changes in UA temperature during apnoea. The temperature of the uvula was significantly lower than that of the other UA regions. For each anatomical region, there were no differences in inspiratory temperature between normals, snorers and SAHS. In normals, the expiratory rewarming was significantly higher in the uvula than in the velum and the posterior pharyngeal wall, whereas these regional differences were not observed in snorers and SAHS. The velum and posterior pharyngeal rewarming was significantly less in normals than in snorers and SAHS. During apnoea, the UA rewarming was similar to that observed during expiration. In conclusion, tissue temperature varies between the different upper airway regions and during tidal breathing and the intensity of the regional expiratory rewarming differs between normals, snorers and patients with sleep apnoea/hypopnoea syndrome.
Prevalence of snoring and sleep breathing-related disorders in Chinese, Malay and Indian adults in Singapore
Authors: Ng TP , Seow A , Tan WC
Published: November 2002

This study investigated the prevalence of snoring and symptoms of sleep breathing-related disorders in the multi-ethnic population of Singapore (3 million people, comprising 75% Chinese, 15% Malay and 7% Indian). A multistaged, area cluster, disproportionate stratified, random sampling of adults aged 20-74 yrs was used to obtain a sample of 2,298 subjects (65% response), with approximately equal numbers of Chinese, Malay and Indian and in each 10 yr age group. An interviewer-administered field questionnaire was used to record symptoms of snoring and breathing disturbances during sleep witnessed by a room-mate and other personal and health-related data. The weighted point estimate (and 95% confidence interval) of the whole population prevalence of snoring was 6.8% (53-83). There were pronounced ethnic differences among Chinese, 6.2% (4.4-8.1); Malay, 8.1% (6.1-10.2) and Indian, 10.9% (85-13.4). The minimum whole population prevalence by the most restricted symptom criteria for defining sleep breathing-related disorder was 0.43% (0.05-0.8%). Similar marked ethnic differences in rates were observed using various symptom criteria. The ethnic differences in sleep breathing symptoms paralleled the differences in body mass index, neck circumference and hypertension, but statistically significant differences remained after adjustment for sex, age and these known associated factors. Marked ethnic differences in snoring and sleep breathing-related disorders were observed in Chinese, Malays and Indians in Singapore, which were only partly explained by known factors of sex, age and body habitus.
Introduction to a new inspiratory threshold loading device
Authors: Chen RC , Que CL , Yan S
Published: November 2002

Inspiratory threshold loading is an important tool in assessing inspiratory muscle function and has been widely used in studies of respiratory mechanics. A simple system was designed to provide a pure and precise inspiratory threshold load. The inspiratory threshold loading system comprises a flow generator attached via a pressure chamber, to the inspiratory port of a Hans-Rudolph valve. By limiting the circulation of air generated by the flow generator between the room and the pressure chamber, different levels of negative pressure are produced in the pressure chamber and applied to the inspiratory valve. An inspiratory pressure equal to the negative pressure in the chamber has to be generated to open the inspiratory valve for flow. The system was tested in four subjects by measuring mouth pressure (Pm), threshold pressure (Pth) and valve resistance (R). The Pm at the beginning of inspiratory flow was defined as the opening pressure (Pop). The Pth was constant throughout inspiration. Pop was linearly related to Pth (p<0.0001), with slopes within 2% of identity and intercepts within +/-0.2 cmH2O. R was between 0.7-1.1 cmH2O x L(-1) x s(-1) under all conditions and was independent of both Pth (p=0.76) and inspiratory flow (p=0.24). The results demonstrate that this system can provide a constant inspiratory threshold load throughout inspiration with little flow resistance, and is therefore ideal for respiratory studies.
Totally implantable venous access devices in cystic fibrosis: complications and patients' opinions
Authors: Rodgers HC , Liddle K , Nixon SJ , Innes JA , Greening AP
Published: November 2002

The introduction of totally implantable venous access devices (TIVAD) has provided a solution to difficult venous access in patients with cystic fibrosis. Early reports have, however, recognized a number of complications with their use. We report our experience with five devices used over 8 yrs with regard to complications and patient attitudes. Patients' notes were reviewed to record the details of TIVAD insertion, duration of function, and complications. In January 1996 the surviving 30 patients were surveyed on their attitudes to TIVAD and complications by written questionnaire. Sixty one ports were implanted in 42 patients (aged 16-47 yrs) between June 1988 and January 1996, giving a total of 1,510 patient-months' experience. The duration of function ranged from 2 weeks to 6 yrs. Survival analysis showed that the median survival of ports was 53 months, 42 out of 61 (69%) had not failed in service at the end of follow-up or patient death. Twenty-three complications occurred in 19 patients. These included: line occlusion (10 patients), venous thrombosis (4), difficult access (3), infection (2), cellulitis (1), inversion of port chamber (2) and pneumothorax (1). The questionnaire showed that patients had strong views on the positioning of their port. Lifestyle issues included interference with seatbelts (8 patients), sport (4), clothing (2), sexual relations (2) and cosmetic appearance (15). Complication rates were similar to those in other studies, although infection rates and salvage of an occluded port were lower. The survey highlighted a number of lifestyle issues, with cosmetic appearance deemed unsatisfactory by half of the patients. However, the majority (28 out of 30) believed their totally implantable venous access devices to be a better alternative to cannulae or long lines.
Cerebral air embolism complicating bilevel positive airway pressure therapy
Authors: Hung SC , Hsu HC , Chang SC
Published: November 2002

A 13 yr old male with acute lymphoblastic leukaemia who received bilevel positive airway pressure ventilation via a face mask for post-transplant pneumonitis developed subcutaneous emphysema, radiographic evidence of pulmonary interstitial emphysema, pneumomediastinum and 6 h later, right hemiparesis and focal livedo reticularis. This case illustrates that severe barotrauma may complicate noninvasive bilevel positive airway pressure ventilation.
Pulmonary capillary haemangiomatosis coexistence with sinus venosus ASD: morphometric analysis and literature review
Authors: Slovis BS , Chazova I , Loyd JE , Meyrick BO
Published: November 2002

A 24 yr old white female presented with dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, cough and fatigue. Transthoracic echocardiography revealed a sinus venosus atrial septal defect (ASD). Right heart catheterization confirmed severe pulmonary hypertension (80/37 mmHg). A chest radiograph showed enlarged pulmonary arteries with peripheral pruning. Surgical repair of the ASD and lung biopsy were performed. Two days later, she developed right heart failure and was treated with inhaled nitric oxide and then a calcium channel blocker. She failed to improve and was readmitted three months later with severe right heart failure and progressive dyspnoea. While waiting for lung transplantation, she developed haematochezia and died. Light microscopy of lung biopsy and autopsy tissue revealed the structural changes of pulmonary hypertension and focal increases in congested pulmonary capillaries consistent with the diagnosis of pulmonary capillary haemangiomatosis. Quantitative analysis demonstrated that the pathological changes were rapidly progressive.
Pain management services in palliative care: a national survey
Authors: Linklater G T , Leng M EF , Tiernan E JJ , Lee M A , Chambers W A
Published: November 2002

Introduction: The effective management of pain requires a multidisciplinary approach. Previous studies have suggested that around 8% of cancer patients will require interventional techniques from an anaesthetist with special interest in pain management to maximize pain control, although this percentage may increase in the cohort of patients with difficult pain syndromes under the care of specialist palliative care services. We wished to determine the experiences and views of other palliative care physicians with regard to input from specialists in pain management. Method: A postal questionnaire was sent to the consultant members of the Association of Palliative Medicine. Results: Most respondents had access to ‘as-required’ anaesthetist consultations with 72% of respondents feeling that the frequency of consultation was adequate. However, over half of the respondents had used the services of a pain management specialist less than four times in the past year and a quarter of respondents had not been involved in a joint consultation with an anaesthetist in the past year. All respondents felt that the pain management specialist's role included advice on technical procedures but less than 25% felt that their role should extend to advice on prescribing analgesics. Discussion: There are likely to be several reasons for this apparent underutilization of specialist anaesthetist/pain management services. This survey has identified possible factors including lack of formal arrangements, lack of suitable experience and the attitudes of palliative medicine consultants.
A new method to obtain and present complete information on the compatibility: study of its validity for eight binary mixtures of morphine with drugs frequently used in palliative care
Authors: Vermeire An , Remon Jean Paul , Schrijvers Dirk , Demeulenaere Peter
Published: November 2002

Parenteral administration of mixtures of morphine with other drugs has become common practice in palliative care. Such mixtures are sometimes found to be incompatible but compatibility data are scarce. An attempt was made to develop a quick and simple investigation strategy to obtain complete information on the compatibility of two drugs. This strategy was then used to study the physical and chemical compatibility of morphine HCl with alizapride HCl, atropine sulphate, dexamethasone sodium phosphate, hyoscine butylbromide, metoclopramide HCl, octreotide lactate, ranitidine HCl and hyoscine hydrobromide. These compatibility data are presented in such a way that they are easy to use in clinical practice. The investigation strategy outlined here allows the collection of complete information on the compatibility of morphine with another drug by studying a limited number of carefully selected mixtures per combination. The mixtures to be studied are selected using a scheme in which all possible mixtures prepared by mixing morphine solutions of varying concentrations with a drug solution in different volume ratios can be visualized. Applying this strategy to the eight combinations revealed, except for ranitidine HCl, no physical (visual) or chemical (HPLC; >90%) incompatibility in any of the mixtures studied for seven days at 22 and 32°C. This indicates that all possible mixtures of these drug solutions with morphine HCl are compatible. For the combination with ranitidine incompatibility was observed only when using morphine HCl solutions containing >40 mg/ml and at certain ratios (drug/morphine HCl [D/M]: 4/42, 10/6 and 8/8, v/v), but all physically compatible mixtures were chemically stable (>90%). Studying extra mixtures in addition to those required to be studied according to the strategy revealed no discrepancies for any of the eight combinations studied. Adaptation of the layout of the scheme and the design of a decision tree resulted in an easy tool to check compatibility in daily practice. The scheme designed in this study is a useful tool for research and for daily practice. It simplifies and thereby encourages investigation of the compatibility of drugs. The availability of data on the physical as well as chemical compatibility in daily practice will contribute to a better quality of the mixtures used in palliative care and help to avoid complications and inadequate symptom control.
Do children with non-malignant life-threatening conditions receive effective palliative care? A pragmatic evaluation of a local service
Authors: Horrocks S , Somerset M , Salisbury C
Published: November 2002

Introduction: A service established in October 1998 aimed to provide nursing and psychological support in the community to families with children who have non-malignant life-threatening illnesses. The purpose of this study was to conduct a pragmatic evaluation of the service. Methods: A before and after study design was used. It incorporated an administered questionnaire survey of carers of children at the time of referral and again after six months, a postal survey of health professionals and an audit of nursing and psychology records. Results: Twenty-nine families were recruited. The children had a wide range of needs. Prior to the service, nearly half were rated by their main carer as experiencing considerable distress. Perceived problems were as frequently due to emotional or practical care needs as due directly to their physical illness. Information and nursing care needs appeared to be improved and distress rating was slightly reduced after the involvement of the service. However, problems with equipment and respite needs were not improved. In general, families were satisfied with central aspects of the service. Conclusions: The service appears to meet most of the expectations of both families and health professionals. However, recommendations include improvement of communication, the provision of a 24-h service and of respite care.
The coverage of cancer patients by designated palliative services: a population-based study, South Australia, 1999
Authors: Hunt Roger W , Fazekas B S , Luke C G , Priest K R , Roder D M
Published: November 2002

Our aims were to determine the extent of coverage by designated palliative care services of the population of terminally ill cancer patients in South Australia, and to identify the types of patients who receive these services and the types who do not. All designated hospice and palliative care services in South Australia notified to the State Cancer Registry the identifying details of all their patients who died in 1999. This information was cross-referenced with the data for all cancer deaths (n=3086) recorded on the registry for 1999. We found that the level of coverage by designated palliative services of patients who died with cancer in 1999 was 68.2%. This methodology was previously used to show that the level of coverage had increased from 55.8% for cancer deaths in 1990 to 63.1% for those in 1993. Patients who died at home had the largest coverage by palliative services (74.7%), whereas patients who died in nursing homes had the lowest coverage (48.4%). Patients who did not receive care from these palliative services tended to be 80 years of age or older at death, country residents, those with a survival time from diagnosis of three months or less, and those diagnosed with a prostate, breast, or haematological malignancy. Gender, socioeconomic status of residential area, and race were not related to coverage by a designated palliative service, whereas migrants to Australia from the UK, Ireland, and Southern Europe were relatively high users of these services. We conclude that the high level of palliative care coverage observed in this study reflects widespread support for the establishment of designated services. When planning future care, special consideration should be given to the types of patients who most miss out on these services.
Differences in understanding of specialist palliative care amongst service providers and commissioners in South London
Authors: Payne S , Sheldon F , Jarrett N , Smith P , Davis C L , Turner P , George S
Published: November 2002

This paper describes a study that sought to identify service providers' and commissioners' understanding of specialist palliative care within the context of changing service provision in one area of South London. Using a formative evaluation framework, we examined the views of 44 providers and commissioners from statutory and voluntary health and social care services about their understanding of specialist palliative care services and, in particular, the remit of current service provision delivered by a Marie Curie Centre. Face-to-face audiotaped semi-structured interviews were conducted. A qualitative thematic analysis highlighted a number of issues including a lack of consensus about definitions of palliative care, ambivalence about referral procedures, and a lack of role clarity between specialist and generalist palliative care providers. The study took place within the real world context of changing services and economic pressures. This raises methodological issues about how services are evaluated and what terminology is used to describe end-of-life care. The study findings confirm that confusion about terminology and referral criteria remain major issues for clinical workers and organizations seeking to access services.