bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful Left Trisegmentectomy for Polycystic Liver Disease Accompanied by Jaundice
Authors: Endo Itaru , Tanabe Mikiko , Tanaka Kuniya , Ishikawa Takashi , Sekido Hitoshi , Togo Shinji , Nakano Akira , Shimada Hiroshi
Published: April 2003

Background: We report a case of severe polycystic liver disease (PLD) with jaundice in a 57-year-old woman who underwent successful left trisegmentectomy. Method: She was admitted for the first time in February 1992 to our hospital with a 7-year history of PLD, and became jaundiced in June 1995. Because normal liver parenchyma was confirmed mainly to the posterior segment, left trisegmentectomy was performed. Results: No postoperative complication occurred. The serum bilirubin level decreased promptly after the operation, but postoperative endoscopic retrograde cholangiography showed that the root of the posterior hepatic duct remained thin. Thus, the elimination of jaundice was presumed to have been caused by a decrease of intra-abdominal and peripheral biliary pressure, since a large volume of tissue had been removed from the peritoneal cavity. She has since remained well without any symptoms. Conclusion: This procedure is useful for severe PLD, because it can be performed safely and the symptoms disappear dramatically. However, further follow-up is needed to determine the long-term effects of this procedure, because the remaining liver has shown some increase in size.
Pylorus-Preserving Pancreatoduodenectomy: Influence of a Billroth I versus a Billroth II Type of Reconstruction on Gastric Emptying
Authors: Goei T.H. , van Berge Henegouwen M.I. , Slooff M.J.H. , van Gulik T.M. , Gouma D.J. , Eddes E.H.
Published: April 2003

Background/Aim: Delayed gastric emptying (DGE) is a frequent problem after pylorus-preserving pancreatoduodenectomy. Important risk factors are the presence of intra-abdominal complications. Searching for other causes, this study evaluates the influence of the type of reconstruction after a pancreatoduodenectomy (Billroth I vs. Billroth II; B I vs. B II on DGE. Methods: A retrospective study was performed evaluating consecutive patients from two surgical institutes. 174 patients were included (B II type of reconstruction n = 123, period 1992–1996; B I type of reconstruction n = 51, period 1988–1998). DGE was defined by gastric stasis requiring nasogastric intubation for 10 days or more or the inability to tolerate a regular diet on or before the 14th postoperative day. Results: After a B I type of reconstruction, there was significantly longer nasogastric intubation period as compared with a B II type of reconstruction (B I median 13 days, range 4–47, B II median 6 days, range 1–40; p < 0.05). There was no difference in postoperative commencement of a normal diet. Also significantly more patients had DGE after a B I (76%) as compared with a B II type of reconstruction (32%; p < 0.05). Conclusions: The results of this study indicate a significantly higher incidence of DGE after a B I type of reconstruction as compared with a B II type reconstruction. The etiology remains speculative.
Disconnective Hemispherectomy
Authors: Danielpour Moise , von Koch Cornelia S. , Ojemann Steven G. , Peacock Warwick J.
Published: April 2003

Hemispherectomy is a valuable procedure in the management of seizure disorders caused by unilateral hemispheric disease. Modifications to anatomical hemispherectomy have been proposed to reduce the incidence of superficial cerebral hemosiderosis and hydrocephalus while still achieving seizure control. We report on the modification of a previously described disconnective form of hemispherectomy. We used this procedure on 2 children, with the aid of stereotactic navigation in 1 of the 2 cases. This disconnection was achieved via a transventricular route with minimal cortical resection or disruption of the blood supply. Over the 20 months of follow-up, 1 patient achieved complete seizure control, and 1 patient achieved control of previously incapacitating seizures with few minor seizures persisting. Motor function and speech significantly improved in both patients. Blood loss during the two procedures was significantly less than that reported for anatomical hemispherectomy, and so far there have been no signs of postoperative complications. The hospital stay was limited to 7–14 days after surgery.
Dietary Support to Underweight Patients with End-Stage Pulmonary Disease Assessed for Lung Transplantation
Authors: Førli Liv , Pedersen Jan I. , Bjørtuft Øystein , Vatn Morten , Boe Jacob
Published: April 2003

Background: Undernutrition in hospitalized patients is often not recognized and nutritional support neglected. Chronic obstructive pulmonary disease is frequently characterized by weight loss. No data exist on the effects of nutritional supplementation in underweight lung transplantation candidates during hospitalization. Objective: To evaluate the effects on energy intake and body weight of an intensified nutritional support compared to the regular support during hospitalization. Methods: The participants were underweight (n = 42) and normal-weight (n = 29) patients with end-stage pulmonary disease assessed for lung transplantation. The underweight patients were randomized to receive either an energy-rich diet planned for 10 MJ/day and 45–50 energy percentage fat and offered supplements (group 1), or the normal hospital diet planned for 8.5–9 MJ/day and 30–35 energy percentage fat and regular support (group 2, control group). The normal-weight control patients (group 3) received the normal diet. Food intake was recorded for 3 days. Results: During a mean hospital stay of 12 days, the energy intake was significantly greater for the patients on intensified nutritional support (median 11.2 MJ) than for the underweight patients on the regular support (8.4 MJ; p < 0.02) and the normal-weight patients (7.0 MJ; p < 0.001). The increase in energy intake in group 1 resulted in a significant weight gain (median 1.2 kg) compared with group 2 (p < 0.01) and group 3 (p < 0.001). Conclusions: In a group of underweight patients with lung disease assessed for lung transplantation, it was possible to increase energy intake by an intensified nutritional support which was associated with a significant weight gain, compared to the regular nutritional support during a short hospital stay.
Bilateral Empyema Caused by Adult-Onset Still’s Disease
Authors: Mattiuzzo M. , Del Forno M. , Branca B. , Moretti V. , Pirisi M.
Published: April 2003

Empyemas are usually of infectious origin. Noninfectious causes of empyema may be a considerable diagnostic challenge, as exemplified in the present case report. A 21-year-old male presented with high fever, sore throat and myalgias of 1 week duration. In the following days, bilateral pleural effusions developed, with cellular counts in the pleural fluid up to 117 × 109/liter (98% neutrophils). Despite institution of empiric antibiotic therapy, spiking fever continued. All culture studies resulted in being negative. Following the report of a serum ferritin concentration of 6,975 µg/l, adult-onset Still’s disease was diagnosed and successfully treated with anti-inflammatory drugs. This case adds adult-onset Still’s disease to the list of noninfectious causes of empyema and underlies the value of measuring serum ferritin as a diagnostic tool.
Hering-Breuer Reflex in Normal Adults and in Patients with Chronic Obstructive Pulmonary Disease and Interstitial Fibrosis
Authors: Tryfon S. , Kontakiotis T. , Mavrofridis Eu. , Patakas D.
Published: April 2003

Background: It has been suggested that the Hering-Breuer reflex (HBR) is unimportant in adults during normal tidal breathing and that it is elicited only if tidal volume is increased above a certain critical threshold. Objective: The aim of this study was (1) to study the occurrence of the HBR in adults with normal pulmonary function and (2) to examine if changes in lung mechanics have any effect on the HBR. Methods: We examined 11 adults with normal pulmonary function, 8 patients with chronic destructive pulmonary disease (COPD) and 3 with interstitial fibrosis (IF). All subjects were lightly sedated with fentanyl, intubated and ventilated with a Servo-900 ventilator. Inspiratory and expiratory flow (and after integration, volume) and mouth pressure were recorded from the endotracheal tube with a pneumotachograph and a pressure transducer. Pressure support ventilation was applied in all patients and functional residual capacity (FRC) was measured with the N2 washout method. Mean (Temean) and maximal expiratory time (Temax) were determined for each individual for 20 breaths. Following several breaths to establish a stable baseline the airway was occluded at end inspiration by a shutter. A positive HBR was interpreted as longer Teocc than Temax (Teocc/Temax, %). Occlusion was maintained until negative airway pressure occurred and the occlusion time (Teocc) was measured. We attempted occlusions after the addition of 5 cm H2O positive end-expiratory pressure (PEEP) and subsequently with 10, 15 and 20 cm H2O PEEP. Teocc was measured of progressively larger lung volumes. To examine the HBR sensitivity in the three groups, we plotted the lung volumes of occlusion against the corresponding Teocc/Temax. Results: The ratio Teocc/Temax increased from 167.5 ± 82.5 at normal FRC to 474 ± 200.2 s (PEEP20). On the contrary, in patients with COPD, Teocc/Temax increased from 125.2 ± 34 to 193.7 ± 74.2 (p < 0.05). Conclusions: The HBR was positive in all subjects. COPD patients were found to be less sensitive to volume changes when compared with normal controls and with IF patients.
Iatrogenic Pneumothorax: Marker Gas Technique for Predicting Outcome of Manual Aspiration
Authors: Kiely David G. , Davey Wayne A. , Mahadevan Venkateswaran , Seaton Douglas
Published: April 2003

Background: Although manual aspiration is used for treating pneumothorax, the post-aspiration radiograph may not be a reliable indicator of whether the pleural leak remains. We have previously shown that marker gas can identify an air leak in patients with spontaneous pneumothoraces. Objective: This study examines whether a marker gas technique can be safely used to manage patients with iatrogenic pneumothoraces. Methods: 10 patients with iatrogenic pneumothorax were identified among a cohort referred for manual aspiration of pneumothorax, using a marker gas technique, in which inspired metered-dose inhaler propellant gas is detectable in pneumothorax aspirate using a portable flame ioniser. The presence of marker gas was taken to imply a persistent air leak. Results: Marker gas was detected in the aspirate from 3 out of 10 pneumothoraces. 2 required intercostal tube drainage because of lung collapse following initial aspiration and 1 was treated conservatively. Marker gas was not detected in 7 cases (2 post-pacemaker insertion, 5 pleural aspiration ± biopsy), and in all these cases, manual aspiration resulted in sustained re-expansion of the lung. There was a trend towards a significant relationship between the presence or absence of marker gas and the need for a further intervention (p = 0.055). Conclusion: The presence or absence of a pleural leak during manual aspiration of iatrogenic pneumothorax can be demonstrated by this technique. The absence of marker gas in the aspirate implies that manual aspiration will be successful, whereas its presence, in most cases, predicts either failure of manual aspiration to expand the lung or early re-collapse of the lung.
Noninvasive Method to Measure Airway Obstruction in Nonanesthetized Allergen-Sensitized and Challenged Mice
Authors: Lin Ching-Chi
Published: April 2003

Background: Conventional methods used to measure bronchoconstriction are invasive, technically demanding and time consuming. Objectives: Our purpose was to evaluate a noninvasive method, by barometric whole-body plethysmography (WBP), to evaluate bronchoconstriction and bronchial hyperreactivity in mice induced by ovalbumin (OA) inhalation challenge in comparison with an invasive method. Enhanced pause (Penh) was used as an index of airway obstruction. Methods: Eight mice were sensitized by OA (group I) and then challenged with OA. Twenty-four hours later, pulmonary function testing (PFT) was measured by WBP at baseline and after a methacholine (MCh) inhalation challenge. Eight weight-matched normal mice served as controls (group II). Four hours after PFT in a nonanesthetized condition, all animals were anesthetized and paralyzed. Baseline PFT was performed by the maximal forced expiratory maneuver (MFEM), and then the animals were given varying doses of acetylcholine (ACh; 25, 50, 75, 100 µg/kg) injected through the jugular vein. Five seconds after ACh injections, pulmonary functions were examined, including MFEM, peak airway pressure and total lung compliance. After completing PFT, bronchoalveolar lavage (BAL) was performed, the animals were sacrificed, and the lungs were examined histologically. Results: Group I had increased Penh in response to MCh in the nonanesthetized condition and decreased flow in the anesthetized condition, characterized by greater decreases in MFEM flow rates MFEF 50% and MFEF 25% than the control group. The peak flows, MFEF 75%, MFEF 50% and MFEF 25%, for group I were lower than those for group II at doses of ACh higher than 25 µg/kg. There were concentration-dependent increases in Penh in response to aerosolized MCh in both groups, but the Penh in response to aerosolized MCh was significantly enhanced in group I when compared with controls. The doses of MCh required for 100% increases in Penh were significantly reduced for sensitized and challenged mice. There was a positive correlation between provocative doses PD200 Penh MCh, PD20 MFEF 50% ACh and PD20 MFEF 25% ACh. There was a negative correlation between the PD200 Penh MCh and the percentage of eosinophils in BAL fluid. There was an increased total cell count and an increased percentage and absolute number of eosinophils and lymphocytes in the BAL fluid of sensitized animals. OA-sensitized mice also had a severe inflammatory reaction of airway and lung tissue, characterized by congestion, edema and inflammatory cell infiltration and desquamation of bronchial epithelial cells. Conclusion: The noninvasive method of WBP can be used to evaluate airway obstruction and hyperreactivity induced in mice by allergen challenge.
Role of Na+-K+-ATPase in Sodium Nitroprusside-Induced Relaxation of Pulmonary Artery under Hypoxia
Authors: Tagaya E. , Tamaoki J. , Kawatani K. , Nagai A.
Published: April 2003

Background: The sodium pump (Na+-K+-ATPase) plays a part in the regulation of smooth muscle contractility, and alterations of enzyme activity by hypoxia could contribute to the mechanism of hypoxic pulmonary vasoconstriction. Objective: To determine the role of Na+-K+-ATPase in the sodium nitroprusside (SNP)-induced relaxation of pulmonary artery in hypoxia. Methods: Using isolated canine pulmonary arterial rings, we measured the relaxant responses of KCI-contracted tissues to SNP under hyperoxic (95% O2, 5% O2) and hypoxic conditions (5% O2, 5% CO2, 90% N2) in vitro. Na+-K+-ATPase activity was assessed by measuring ouabain-sensitive 86Rb uptake. Results: The SNP-induced relaxation was reduced under hypoxia, so that the maximal relaxation decreased from 80.1 ± 8.6 to 57.8 ± 6.8% (p < 0.01) and the concentration of SNP required to produce 50% relaxation increased from 1.9 ± 0.4 × 10–6 to 2.6 ± 0.6 × 10–5M (p < 0.01). Addition of ouabain, an Na+-K+-ATPase inhibitor, attenuated the relaxant response to SNP and this inhibition was still observed under hypoxia. Incubation of endothelium-denuded rings with SNP caused dose-dependent increases in intracellular cGMP levels and ouabain-sensitive 86Rb uptake, and these effects were not significantly altered by hypoxia. Conclusion: These results suggest that sarcolemmal Na+-K+-ATPase activity may be implicated in the mechanism of nitrovasodilator-induced vasodilation of pulmonary artery and may still be functioning under hypoxia.
Colonization with Schizophyllum commune of Localized Honeycomb Lung with Mucus
Authors: Iizasa Toshihiko , Kamei Katsuhiko , Chiyo Masako , Suzuki Makoto , Baba Masayuki , Toyosaki Tetsuya , Hiroshima Kenzo , Ohwada Hidemi , Kanno Shigeharu , Nishimura Kazuko , Fujisawa Takehiko
Published: April 2003

We report a surgical case involving localized honeycomb lung with mucus, caused by colonization of a Schizophyllum commune, which displayed a tumorous shadow in the right upper mediastinum. A 74-year-old male with a history of tuberculosis in the 1970s was referred to Chiba University Hospital (Chiba, Japan) with an abnormal shadow evident in the chest roentgenogram. A transbronchial biopsy failed to yield a definite diagnosis. We resected the right upper lobe, which was found to contain a consolidative lesion filled with viscous mucus in the right upper lobe adjacent to the right upper mediastinum. Microscopic examination revealed a honeycomb lung formation with mucus in the destroyed space. Culture of the mucus yielded a whitish filamentous fungus, positively identified as S. commune. This is the first report of S. commune leading to a deposit of mucus and the formation of a consolidative lesion in the destroyed lung.
Pulmonary Alveolar Microlithiasis: A Rare Familial Inheritancewith R eport of Six Cases in a Family
Authors: Senyigit A. , Yaramiş A. , Gürkan F. , Kirbaş G. , Büyükbayram H. , Nazaroglu H. , Alp M.N. , Topçu F.
Published: April 2003

Pulmonary alveolar microlithiasis (PAM) is a lung disease characterized by deposits of calcium within the alveoli. Our aim was to emphasize the familial character and the clinical features of the disease, and to draw attention to the increasing number of Turkish patients reported in the world. We detected 6 cases of PAM. Three cases had been diagnosed 4 years earlier, and 3 new cases were detected during the screening of the family members. All patients were male and the mean age was 11.5 ranging between 5 and 29 years. Five of the patients were cousins and the other one was their uncle. Radiographic studies showed a sand-like appearance in all patients. One case showed small subpleural bullae and bronchiectatic changes in both lower lobes in recent high-resolution CT scans, while his CT performed 4 years ago showed only sand-like appearance. The cases were diagnosed with the demonstration of microliths by bronchoalveolar lavage in 5 patients and transbronchial biopsy in 1. Recently reported cases from Turkey have constituted a considerable percentage among all cases in the world. In conclusion, (1) our patients constitute one of the largest series of cases reported in one family in the world. The disease seems to have familial and racial characteristics. The Turkish race has to be further investigated for genetic transmission. (2) Contrary to female predominance in previous reports, all 6 cases were male and 5 of them were below 12 years of age. (3) The disorder may show rapid progression in some cases probably due to the severity of the genetic disturbance.
A Population-Based Prescription Study of Asthma Drugs during Pregnancy: Changing the Intensity of Asthma Therapy and Perinatal Outcomes
Authors: Olesen Charlotte , Thrane Nana , Nielsen Gunnar Lauge , Sørensen Henrik Toft , Olsen Jørn
Published: April 2003

Background: Among the goals of gestational asthma, therapy is optimisation of pulmonary function. According to the US Food and Drug Administration, no asthma drugs can be considered ‘safe’ during pregnancy. Fear of adverse fetal effects may thus lead to restrictive use of asthma drugs during pregnancy, and no population-based studies concerning gestational asthma therapy exist. Objectives: To examine whether asthma drugs or changing intensity of asthma therapy during pregnancy was associated with deviations from expected values of gestational age, birth weight, length at birth, or malformations. Methods: The Birth Registry was used to identify all 15,756 primiparous women who gave birth in the County of North Jutland between 1991 and 1996. According to the North Jutland Prescription Database, 303 of these women received prescriptions for asthma drugs during pregnancy. Women who did not purchase any prescription drugs during pregnancy constituted the reference group. Conclusion: Women who received prescriptions for asthma drugs during pregnancy gave birth to infants with birth weight and length at birth within the expected limits. Reducing intensity of asthma treatment during pregnancy was associated with lower birth weight and length at birth. This may indicate that pregnant women chose to discontinue therapy although their disease severity justifies continuation of treatment. However, analyses did not take into account important clinical variables, and results could also be due to confounding factors or chance.
Pulmonary Function in Non-Insulin-Dependent Diabetes mellitus
Authors: Marvisi Maurizio , Bartolini Lino , del Borrello Patrizia , Brianti Marco , Marani Giuseppe , Guariglia Achille , Cuomo Angelo
Published: April 2003

Background: In type I diabetes mellitus, lung function has been investigated in several clinical studies, but there are few data concerning pulmonary function abnormalities in patients with non-insulin-dependent diabetes mellitus (NIDDM). Objectives: The aim of this study was to assess the presence of pulmonary function abnormalities in patients with NIDDM and to verify the possible associations between diabetic renal microangiopathy, retinopathy and diabetes control. Method and Patients: Thirty patients with NIDDM were collected and divided into two similar groups: subjects with retinopathy and/or diabetic glomerulopathy (group 1, n = 15) and patients without any complications (group 2, n = 15). 17 were males and 13 females, aged from 45 to 81 years. They had had diabetes for 3–23 years and were studied at the Division of Internal Medicine, with an outpatient service for diabetic patients. All patients were non-smokers. The presence of diabetic glomerulopathy was determined by measuring the 24-hour protein excretion rate using the nephelometric method. The presence of retinopathy was determined by using ophthalmoscopy. Glycosylated hemoglobin was measured as an indicator of glycemic control. We performed a global spirometry and measured pulmonary diffusion capacity by the single-breath method corrected by alveolar volume. Results: We found a significant reduction in lung diffusion capacity for carbon monoxide (DLCO) in the group of patients with other signs of diabetic microangiopathy (p < 0.005) and a significative correlation between DLCO and the grade of albuminuria (r = –0.83, p < 0.001). Conclusions: Pulmonary function abnormalities, in particular a reduction in diffusion capacity, are common in patients with NIDDM and signs of diabetic microangiopathy. A possible explanation is related to an impaired pulmonary microvasculature and alveolar epithelial basal lamina.
Evidence of a Restrictive Spirometric Pattern in Older Thalassemic Patients
Authors: Filosa A. , Esposito V. , Meoli I. , Stefanelli F. , Cassandro R.
Published: April 2003

Background: Lung impairment represents one of the complications of thalassemia major whose clinical picture can remain in subclinical form all life long. Few works have been published and the results are contradictory. Objectives: The aim of this study was to determine the spirometric pattern, the age of onset in thalassemic boys and girls, and to investigate the association with the onset of endocrinological complications. Methods: We studied 48 patients, divided into three groups according to pubertal stages, in order to better distinguish the periods of life in which different endocrinological complications usually appear. Group A: (n = 14; 8 F, 6 M; age 10.8 ± 1.7 years): prepubertal patients; group B (n = 21; 10 F, 11 M; age 15.7 ± 1.1 years): pubertal patients; and group C (n = 13; 9 F, 4 M; age 19.0 ± 1.4 years): postpubertal patients. Pulmonary function tests (PFTs) and diffusing capacity for carbon monoxide (DCO), corrected for both Hb values (DCO*) and alveolar volume (KCO), were performed 2 days after blood transfusion and were considered pathologic when they fell below 80% of the predicted value. Results: All patients in group A showed normal PFTs, DCO* and KCO values, as well as normal endocrinological assessment. By contrast, all those in group C showed a restrictive spirometric pattern with reduced DCO* (63 ± 8%), elevated KCO values (120 ± 14%), a variable degree of hypoxia (PO2 82 ± 9%), and high serum ferritin levels. Only 2 patients showed a radiological picture of interstitial fibrosis. Furthermore, 9 patients had hypogonadism and 3 hypothyroidism. In group B, only 3 patients showed a restrictive pattern and 1 of them reduced DCO* values, and 2 out of 3 patients had hypogonadism. Considering all patients on the whole, DCO* was negatively correlated with both serum ferritin (r = –0.58; p < 0.05) and age (r = –0.57; p < 0.05). Conclusions: The presence of a restrictive pattern in 16 older patients associated with both high serum ferritin levels and endocrinological complications in a lot of them was the main feature in this study. Iron overload might be the main factor determining lung impairment, even though a more accurate evaluation is necessary. Possible pathological mechanisms and the role of the genotype are discussed.
N-Omega-Nitro-L-Arginine Methyl Ester Increases Airway Responsiveness to Serotonin but Not to Acetylcholine in Cats in vivo
Authors: Aizawa H. , Takata S. , Shigyo M. , Matsumoto K. , Inoue H. , Hara N.
Published: April 2003

Background: We previously reported that Nω-nitro-L-arginine methyl ester (L-NAME) enhances airway responsiveness to inhaled serotonin in cats treated with atropine and propranolol. Objective: To further elucidate the role of nitric oxide (NO) in airway responsiveness, we investigated whether L-NAME induces airway hyperresponsiveness to serotonin and acetylcholine (ACh) in animals with intact innervation. Methods: Cats were anesthetized with pentobarbital sodium (50 mg/kg, i.p.), and mechanically ventilated. To assess airway responsiveness, we measured increase in total pulmonary resistance (RL) produced by delivering serotonin or ACh aerosol to the airway, and determined PC200 (the concentration which caused a 200% increase in RL). Results: The following results were obtained: (1) Airway responsiveness to serotonin was significantly enhanced by the administration of L-NAME (100 mg/kg) in animals treated with atropine and propranolol. (2) Airway responsiveness to serotonin was also significantly enhanced by L- NAME in animals with intact innervation. (3) In contrast, airway responsiveness to ACh was not changed by the addition of L-NAME in cats with intact innervation. Conclusion: These results suggest that NO modulates nonspecific airway responsiveness in animals with intact innervation, presumably by a reflex mechanism.
Chronic Bronchiolitis with Associated Eosinophilic Lung Disease (Eosinophilic Bronchiolitis)
Authors: Takayanagi Noboru , Kanazawa Minoru , Kawabata Yoshinori , Colby Thomas V.
Published: April 2003

We encountered an adult patient with dyspnea, eosinophilia and bronchiolitis. He was diagnosed as having diffuse panbronchiolitis, and was treated with erythromycin for 3 years, but his symptoms had gradually worsened. Bronchoalveolar lavage showed marked eosinophilia, and video-assisted thoracoscopic lung biopsy revealed chronic bronchiolitis with associated eosinophilic lung disease (eosinophilic bronchiolitis). To our knowledge, no case of eosinophilic bronchiolitis has been reported in the literature.
Acute Dyspnoea Resulting from Pulmonary Oedema as the First Sign of a Phaeochromocytoma
Authors: van Iperen C.E. , Giezen J. , Kramer W.L.M. , Lips C.J.M. , Bartelink A.K.M.
Published: April 2003

The day after undergoing neck dissection, a 42-year-old woman developed acute dyspnoea due to pulmonary oedema. Measurements with a Swan-Ganz catheter revealed not only cardiac depression but also a greatly increased peripheral vascular resistance: 5,400 dyn·s· cm–5/m2. A phaeochromocytoma with acute cardiac failure leading to pulmonary oedema was considered. Treatment with α- and β-blockers was complicated by severe hypotension and later ventricular fibrillation. Mechanical ventilation was required for 6 days following resuscitation. Investigation of the urine subsequently showed greatly increased catecholamine concentrations, while imaging revealed bilateral adrenal tumours. Our case history shows that acute pulmonary oedema may be the presenting manifestation of a phaeochromocytoma. The pulmonary oedema resulted partly from backward failure following tachycardia, myocyte necrosis and the greatly increased peripheral vascular resistance, and partly from increased permeability of the capillary network in the lungs.
Management of COPD: Surgical Options
Authors: Palange Paolo
Published: April 2003

Dyspnoea on exertion and exercise intolerance are the hallmarks of chronic obstructive pulmonary disease (COPD); the primary causes appear to be respectively, increased airway resistance with reduced maximal ventilatory capacity and peripheral skeletal muscle dysfunction with early onset of anaerobic metabolism. Patients with end-stage COPD usually show little or no benefit from conventional medical treatment. Physical training is capable of ameliorating exercise tolerance, but improvement is usually modest in the advanced disease state. Two surgical options are generally accepted for carefully selected patients with emphysema: resection of large bullae, when identified, and lung transplantation. Transplantation, the only effective cure for advanced COPD, is of limited use primarily because of age, comorbidity, limited availability of organs and cost. A different approach for severe emphysema, lung volume reduction surgery (LVRS), has been increasingly utilized during the past several years. In carefully selected emphysematous patients, LVRS improves lung volumes and mechanics, and reduces exertional dyspnoea. Unfortunately, surgical mortality still remains high and some patients show no measurable improvement after surgery. There is an urgent need for data on long-term effects of LVRS; the results of large, randomized trials will soon be forthcoming. The aim of this brief review is to summarize the available knowledge on the effects of LVRS, the criteria for patient selection, short- versus long-term effects and, finally, to propose future directions in this field.
Prevalence of Habitual Snoring in a Sample of French Males
Authors: Teculescu D. , Hannhart B. , Cornette A. , Montaut-Verient B. , Virion J.-M. , Michaely J.-P.
Published: April 2003

Background: No data on snoring prevalence obtained with a standard questionnaire exist for France. Major nose-throat abnormalities have been demonstrated in cases with obstructive sleep apnea; evidence of ‘minor’ abnormalities in community studies is scarce. Objectives: The fist objective of our study was to estimate the prevalence of habitual snoring in a sample of middle-aged active males in France. The second objective was to test the hypothesis that ‘minor’ nose-throat abnormalities could be associated with habitual snoring in a field survey. Methods: Three hundred thirty-four male employees of a local university volunteered for the study (93.6% of those contacted by mail); 300 returned a sleep questionnaire. The protocol also included anthropometry and a noninvasive nose-throat examination. Results: Complete data were obtained in 299 subjects aged 23–63 years. When ‘habitual snorers’ (= 32%) were compared with never-snorers, significant differences were found for all anthropometric variables, except height. In univariate analysis, habitual snoring was associated with a large number of variables, including a large soft palate, a large uvula, and altered nose patency. A logistic regression model retained 8 factors independently associated with snoring: age, neck circumference, tobacco consumption, breathing pauses during sleep, not feeling rested during the day, need for coffee to stay awake, blocked or running nose at night and a large soft palate. Conclusions: The prevalence of habitual snoring in this sample of middle-aged French males was 32%. We confirmed the significant association of habitual snoring with age, weight excess, and tobacco smoking, and identified two further factors: blocked nose at night and a large soft palate.
Diagnostic Value of D Dimer in Pulmonary Embolism and Pneumonia
Authors: Jiménez Castro David , Pérez-Rodríguez Esteban , Montaner Luis , Flores Julio , Díaz Nuevo Gema
Published: April 2003

Background: Diagnosis of pulmonary embolism (PE) and its clear-cut differentiation with other entities of occasional similar presentation remains difficult in routine clinical practice. High plasmatic levels of D dimer (DD), a specific fibrin derivate, have recently been reported in PE. Objective: The purpose of this study was to prospectively evaluate the diagnostic value of plasmatic DD in a clinical setting. Methods: We studied 52 patients with PE proven with pulmonary scintigraphic studies in relation to 19 patients posteriorly diagnosed of having community-acquired pneumonia and 30 healthy subjects. Evolution of DD levels whilst the patients were on intravenous anticoagulant therapy was evaluated by measuring DD concentration on admission and on day 7 in 10 patients. Results: Plasma DD levels were significantly higher in PE in relation to controls (p < 0.001). DD levels were also higher in patients diagnosed with community-acquired pneumonia in relation to controls (p < 0.05) but lower than those obtained in high probability PE (p < 0.05). Sensitivity and specificity of plasmatic DD in the emergency diagnosis of PE are of 92 and 71%, respectively. Plasma levels of DD were found to progressively decrease during the first week of heparin therapy, but they remained higher than in control subjects. Conclusions: Plasma DD levels are increased in patients with suspected PE and the degree of elevation is related to the results obtained in scintiscans. Moreover, DD concentrations progressively decrease during the first week of anticoagulant therapy. The increased DD levels found in patients with pneumonia make this test useless in the differential diagnosis between these two clinical entities.
Pulmonary Nocardiosis: Clinical Experience in Ten Cases
Authors: Mari Begoña , Montón Concepción , Mariscal Dolors , Luján Manel , Sala Montserrat , Domingo Christian
Published: April 2003

Background: Pulmonary nocardiosis is an infrequent infection whose incidence seems to be increasing due to a higher degree of clinical suspicion and the increasing number of immunosuppressive factors. Objective: To study the predisposing factors, clinical characteristics, diagnostic procedures, treatment and progress of pulmonary nocardiosis (PN). Methods: Review of 10 patients (9 male, 1 female, mean age 61) with PN in a 600-bed teaching hospital, diagnosed from 1992 to 1999. Results: Associated diseases observed were chronic obstructive pulmonary disease (COPD) in 6 patients, human immunodeficiency virus (HIV) infection in 3 and polymyalgia rheumatica in 1. Four patients had received oral corticotherapy for COPD for over a year (mean dose 13 mg/day of prednisone or equivalent). The main reason for consultation was an increase in dyspnea in the patients with COPD (6/6) and fever in those with HIV (3/3). Mean time between onset of symptoms and diagnosis was 5 weeks. In 8 patients, the infection occurred outside the hospital setting. The infection was restricted to the lung in 9/10; in the remaining case, the central nervous system (CNS) and subcutaneous tissue were affected. Lobar or multilobar consolidation was the most frequent radiographic pattern found (6/10). Sputum culture was positive when performed (8 cases). Diagnosis was made or confirmed by bronchoscopy (bronchoaspirate or protected specimen brush) in 5 patients. Germs isolated were: Nocardia asteroides (8/10), Nocardia farcinica (1/10), Nocardia otitidiscaviarum (1/10). Cotrimoxazole was the most used empirical treatment (6/10). Resolution was achieved in 5 cases. Four subjects died: 1 HIV patient with disseminated nocardiosis, and 3 COPD patients, 2 of whom had received long-term corticotherapy. Illness recurred in only 1 case, due to failure to comply with treatment. Conclusions: (1) In our geographical setting Nocardia presents as a subacute or chronic pulmonary infection, mainly outside the hospital. (2) It tends to affect only the lung. (3) Diagnosis requires a high clinical suspicion, and can be made on the basis of a sputum culture. (4) Nocardia tends to attack patients with underlying COPD, or immunodepressed patients treated with glucocorticoids, or patients with HIV infection. (5) Mortality is high in both COPD and HIV patients. (6) In our area, cotrimoxazole seems to be the most commonly prescribed treatment.
Obstructive Granulomatous Bronchiolitis due to Mycobacterium avium Complex in an Immunocompetent Man
Authors: Grimes Margaret M. , Cole Timothy J. , Fowler III Alpha A.
Published: April 2003

While the development of pulmonary disease due to Mycobacterium avium complex (MAC) infection is most commonly associated with underlying predisposing factors, this organism occasionally causes symptomatic disease in otherwise normal individuals. Patients with MAC pulmonary disease most often present with cavitating granulomas, but a spectrum of pathologic changes has been described. The authors present a case of MAC pulmonary disease in an immunocompetent, middle-aged man with no identified predisposing factors. The diagnostic biopsy disclosed the unusual finding of noncaseating granulomas with predominant involvement of bronchioles, corresponding to the patient’s obstructive and restrictive pulmonary dysfunction.
Tetracycline Aspiration
Authors: Sundar Krishna M. , Elliott C. Gregory , Thomsen George E.
Published: April 2003

A 74-year-old woman presented with a 2-day history of cough, dyspnea and wheezing following aspiration of a tetracycline tablet. She developed a left lower lobe pneumonitis, and bronchoscopy revealed left main bronchus narrowing and exudate. The course of this patient is discussed in reference to the available literature on toxic aspirations.
Possible Relevance of Virus Infection for Development of Analgesic Idiosyncrasy
Authors: Nakagawa Hiroshi , Yoshida Satoshi , Nakabayashi Masaru , Akahori Kazuhito , Shoji Tatsuhiro , Hasegawa Hiroshi , Amayasu Hideaki
Published: April 2003

Although it has been hypothesized that analgesic idiosyncrasy could be acquired by viral infection, there is no evidence that any virus can cause sporadic cases of aspirin-intolerant asthma. We report a case, which points to the possible relevance of herpes simplex virus (HSV) infection for development of analgesic idiosyncrasy. We examined the patient to evaluate whether analgesic idiosyncrasy might have been acquired by viral infection. Sulpyrine provocation testing was performed to confirm the patient’s development of analgesic idiosyncrasy and methacholine provocation testing was performed to assess bronchial hyperresponsiveness. The titer of anti-HSV IgG antibody was measured to confirm viral infection. Sulpyrine provocation testing revealed that hypersensitivity to analgesics had appeared in this patient. In contrast, the marked improvement of her bronchial hyperresponsiveness was confirmed by a PC20 methacholine of 0.63 mg/ml 1 week after sulpyrine provocation testing. The anti-HSV IgG antibody confirmed recent HSV infection. To the best of our knowledge, this is the first reported case of acquired analgesic idiosyncrasy following HSV infection.
Reduced Activation of Peripheral Blood Neutrophils after Late-Phase Asthmatic Responses but Not in Mild Stable Asthma
Authors: Mattheyse Frederick J. , van Heerden Kim , Mattheyse Mary , Williams Zelda , Bouic Patrick , van Schalkwyk Emmerentia M. , Bardin Philip G.
Published: April 2003

Background: Asthma is a process of chronic allergic inflammation that may be worsened by the activation of neutrophils during acute exacerbations. Objective: We investigated our hypothesis that changes in cellular activation may be detectable in peripheral blood (PB) during late-phase asthma and during clinical exacerbations. Methods: Twenty-one stable asthmatics (9 on treatment with β2-agonists only, 12 using inhaled corticosteroids) and 10 nonasthmatic volunteers were first compared using flow cytometry to measure β2-integrin (CD11b/CD18) expression. Production of reactive oxygen species (ROS) was evaluated employing chemiluminescence. Next, 8 mild asthmatics were assessed using similar methods before and after allergen-induced late asthmatic reactions (LARs). Finally, 4 asthmatic subjects were evaluated over 3 months, and symptoms, peak expiratory flow (PEF) and ROS production were measured. Episodes of respiratory morbidity (exacerbations) were identified and their association with ROS production was examined. Results: No differences were detected in adhesion molecule expression and ROS production comparing the normal and asthmatic groups. However, after development of the LAR, significant reductions in CD11b neutrophil expression (mean fluorescence intensity; MFI) were observed [before: 994 ± 102 MFI (mean ± SEM) versus after: 424 ± 81 MFI; p < 0.01]. Furthermore, strong associations were found between decreases in CD11b and the severity of the LAR (r = 0.9; p < 0.02). In the clinical study, ROS production was significantly lower during exacerbations (median 43%; p < 0.05). Again, this measurement was significantly associated with reductions in PEF (r = 0.5, p < 0.03). Conclusions: In patients with mild stable asthma, no differences in the activation of circulating neutrophils were detectable compared to nonasthmatic individuals. During episodes of asthmatic airway obstruction, in the laboratory and in clinical disease, neutrophil activation decreased in PB, conceivably because activated cells may be preferentially sequestered in the lung.
Serial Pentamidine Levels in Bronchial Epithelial Lining Fluid after Aerosol Administration
Authors: Yamamoto H. , Koizumi T. , Miyahara T. , Kaneki T. , Kubo K.
Published: April 2003

Background: There is no information on serial pharmacokinetic assessment in the lungs after administration of aerosolized pentamidine. Objective: The present study was performed to evaluate the elimination of aerosolized pentamidine from bronchial airways following inhalation. Methods: We used 4 sheep with tracheotomies in the present study. Pentamidine (300 mg) was administered by inhalation to each animal. Serial bronchial washing to obtain epithelial lining fluid (ELF) was performed 1, 7, 10, 14, 21 and 28 days after administration of aerosolized pentamidine in each animal. The pentamidine concentration in the supernatant of ELF was measured by high-performance liquid chromatography. Results: The maximal pentamidine level on the first day (12 h after inhalation) was 616.5 ± 238.2 ng/ml (mean ± SE) in ELF. The pentamidine levels rapidly decreased within 2 weeks (8.9 ± 1.2 ng/ml at 14 days), followed by slow elimination (8.9 ± 0.8 ng/ml at 28 days). Thus, inhaled pentamidine showed a rapid clearance from the bronchial wall within the first 2 weeks. Conclusions: These findings may be useful in designing and interpreting future studies of aerosolized pentamidine in patients who are receiving inhaled pentamidine, especially for those with failure of prophylaxis for Pneumocystis carinii pneumonia.
Comparison of Hydrofluoroalkane-Beclomethasone Dipropionate AutohalerTM with Budesonide TurbuhalerTM in Asthma Control
Authors: Worth H. , Muir J.F. , Pieters W.R.
Published: April 2003

Background: Hydrofluoroalkane-beclomethasone dipropionate AutohalerTM (HFA-BDP AH) is a breath-actuated chlorofluorocarbon (CFC)-free metered dose inhaler in which BDP is in a solution of HFA propellant. Budesonide TurbuhalerTM (BUD TH) is a breath-dependent dry powder inhaler. Objectives: To test the hypothesis that half the daily dose of HFA-BDP AH would provide an equivalent control of asthma symptoms to the BUD TH. Methods: This was an 8-week open study in patients with symptomatic moderate-to-severe asthma, previously on BUD 500–1,000 µg day–1, or an equivalent. After 5–14 days’ run-in, patients were randomized to HFA-BDP AH 800 µg day–1 or BUD TH 1,600 µg day–1. The intent-to-treat population consisted of 111 patients on HFA-BDP AH and 98 patients on BUD TH. Results: Mean change from baseline in PEF in the morning (AM PEF) at week 8 was 23.95 liters min–1 for HFA-BDP AH and 24.46 liters min–1 for BUD TH. A two-sided equivalence test using the 0.51 liter min–1 difference gave 95% confidence intervals within a defined equivalence interval of (–∞, 25 liters min–1) indicating that the mean change in AM PEF was equivalent for the two groups. There were no significant differences in the mean change from baseline in FEV1 or β-agonist use. Patients using HFA-BDP AH had a significantly greater mean change from baseline in the percentage of days free from shortness of breath (p = 0.05), chest tightness (p = 0.02) and nights without sleep disturbance (p = 0.04) at week 3, and wheeze (p = 0.01), shortness of breath (p = 0.02), chest tightness (p < 0.01) and daily asthma symptoms (p = 0.03) at week 8. The incidence, type and severity of adverse events were similar in each group. At week 8, the mean change from baseline in corrected urine cortisol/creatinine ratio in a subgroup of patients was –0.36 for HFA-BDP and –4.88 for BUD TH (p < 0.01). Conclusions: HFA-BDP 800 µg day–1 provided control of moderate-to-severe asthma with efficacy and safety at least similar to BUD TH 1,600 µg day–1.
Bronchial Sleeve Resection with Complete Preservation of the Lung for Carcinoma
Authors: Ohta Y. , Yachi T. , Oda M. , Sato H. , Shimizu J. , Watanabe Y. , Watanabe G.
Published: April 2003

Conservative sleeve resection with complete preservation of the lung parenchyma is very rarely applicable for the treatment of bronchial carcinomas. We used this surgical procedure in four patients with bronchial carcinoma in various sites of the central airway, and we obtained successful results. The pathological types were two squamous cell carcinomas and two low-grade malignant tumors (mucoepidermoid carcinoma and adenoid cystic carcinoma). If patients are properly selected, this operative procedure appears to be a safe and radical therapeutic option for the treatment of bronchial neoplasms arising from major bronchi.
Takayasu’s Arteritis Presenting with Bilateral Parenchymal Consolidations and Severe Respiratory Failure
Authors: Çilli Aykut , Özdemir Tülay , Öğüş Candan
Published: April 2003

This is a report of an unusual case of Takayasu’s arteritis presenting with bilateral parenchymal infiltrations and severe respiratory failure caused by pulmonary hemorrhage. The patient was initially diagnosed and treated as protracted pneumonia. After the diagnosis of Takayasu’s arteritis, she was successfully treated with high-fractioned oxygen and corticosteroid therapy.
Pancreatic Carcinoma: Imaging Update 2001
Authors: Freeny Patrick C.
Published: April 2003

This paper discusses the most recent advances in imaging of pancreatic carcinomas. The specific modalities discussed include helical computed tomography (HCT) with combined CT angiography, magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP), and positron emission tomography (PET). Endoscopic ultrasound is discussed in other papers. HCT is believed to be the most efficacious modality for initial detection and staging of pancreatic carcinomas. It has an accuracy rate of about 95–97% for the detection of carcinomas and of virtually 100% for staging unresectable carcinomas. The accuracy for CT staging of a resectable tumor is about 80–85%, with small surface metastases to liver and peritoneum being the most often missed findings. MRI and MRCP are best used for evaluation of patients that cannot receive intravenous contrast media for HCT and of patients who have equivocal HCT findings. PET imaging may be useful for detection of extrapancreatic nodal metastases.