bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Ethanolamine Oleate as a Pleural Sclerosing Agent in Rabbits
Authors: Teixeira Lisete R. , Vargas Francisco S. , Carmo Alipio O. , Silva Lea M.M.F. , Marchi Evaldo , Light Richard W.
Published: April 2003

The ideal pleural sclerosing agent should be easily administered, without significant side effects, inexpensive, and widely available. None of the agents presently used meets all of these criteria. Ethanolamine oleate (ETH) is a sclerosing agent used in the sclerotherapy treatment of varicose veins of the legs and esophagus. The objective of the present study was to assess the efficacy of ETH as a pleural sclerosant in rabbits. An additional objective was to assess if better results were obtained when dextrose 50% (D50) as opposed to saline was used as the diluent. Each group of 10 rabbits received a total volume of 2 ml intrapleurally. The eight treatments were as follows: (1) 2 ml saline; (2) 2 ml D50; (3) 25 mg ETH plus 1.5 ml saline; (4) 25 mg ETH plus 1.5 ml D50; (5) 50 mg ETH plus 1.0 ml saline; (6) 50 mg ETH plus 1 ml D50; (7) 75 mg ETH plus 0.5 ml D50, and (8) 100 mg ETH. The rabbits were sacrificed 28 days after the injection. The intrapleural instillation of ETH resulted in evident pleurodesis, which was dose-dependent; 100 mg ETH induced significantly (p < 0.05) more adhesions than did any other treatment. The selection of the diluent had no effect on the pleurodesis. The microscopic examination of the right visceral pleura showed that the mean degree of fibrosis after 100 mg ETH was significantly (p < 0.05) greater than that after the other solutions. The mean degree of pleural inflammation, lung inflammation and lung fibrosis was minimal in all the groups. From this study we conclude that undiluted ETH produces pleurodesis in our experimental model. At the doses used, the pleurodesis was less than that produced after talc, tetracycline derivatives or silver nitrate in the same model.
Decompensated Cor pulmonaleas the First Manifestation of Ad ult-Onset Myopathy
Authors: Kurz David , Aguzzi Adriano , Scherer Thomas A.
Published: April 2003

A 46-year-old white female was admitted for decompensated cor pulmonale (CP). It had not interfered with her daily activities and she had not experienced shortness of breath, fatigue or muscle weakness prior to the onset of right heart failure. A thorough investigation revealed severe generalized muscle weakness with restrictive chest bellows disease and secondary CP (mean pressure in the pulmonary artery 60 mm Hg). After having refused respiratory support the patient died a few days after admission. The muscle biopsy was consistent with adult-onset acid-maltase deficiency. This is a rare case of metabolic myopathy presenting as decompensated CP without previous symptoms of muscle weakness. This condition can easily be treated with nocturnal ventilatory support, improving the quality and length of life.
Chronic Eosinophilic Pneumonia with Atypical Radiographic Presentation
Authors: Laufs Ulrich , Schneider Christian , Wassermann Klaus , Erdmann Erland
Published: April 2003

Chronic eosinophilic pneumonia (CEP) is a rare disease characterized by a progressive symptomatic deterioration of more than 1 month, pulmonary infiltrates with eosinophils, and a dramatic response to corticosteroid treatment. We describe a patient with CEP who presented with right upper lung infiltrates with evidence of cavitation.
Tuberculosis and HIV Infection: A Global Perspective
Authors: Murray John F.
Published: April 2003

The incidence of HIV-associated tuberculosis has been increasing worldwide since the beginning of the AIDS epidemic, and is expected to increase even further during the foreseeable future, especially in developing countries. There is no doubt now that, in the presence of HIV infection, new-onset tuberculous infection progresses rapidly to clinically significant disease and the likelihood that latent tuberculous infection progresses rapidly to clinically significant disease and the likelihood that latent tuberculous infection will reactivate is enormously increased. The accelerating and amplifying influence of HIV infection is contributing to the increasing incidence of disease caused by multidrug-resistant strains of Mycobacterium tuberculosis. Neither clinical features nor radiographic abnormalities reliably distinguish the majority of patients with HIV-associated tuberculosis from those without HIV infection. Some persons with HIV infection, however, present with atypical manifestations of tuberculosis and these patients may be difficult to diagnose. Six months of daily or thrice weekly chemotherapy with the usual regimen of 4 then 2 antituberculosis drugs cures most patients, but many die during or after treatment of other AIDS-related complications.
Inhalation by Nebulization of Albuterol-Ipratropium Combination (Dey Combination) Is Superior to Either Agent Alone in the Treatment of Chronic Obstructive Pulmonary Disease
Authors: Gross Nicholas , Tashkin Donald , Miller Randall , Oren Joseph , Coleman William , Linberg Steven , Dey Combination Solution Study Group D
Published: April 2003

Combination bronchodilator therapy for chronic obstructive pulmonary disease (COPD) potentially can provide increased benefit over single-agent therapy. The objective of this double-blind, randomized, positive-control trial was to determine the effectiveness of an albuterol-ipratropium solution aerosol combination (Dey combination solution, Dey LP, Napa, Calif., USA) compared with solution aerosols of both component medications administered alone in patients with COPD. The trial consisted of a 6-week, 3-period crossover phase followed by a 6-week parallel phase during which patients self-administered study medications by inhalation from a nebulizer. A total of 863 patients were initially randomized to each of the six possible treatment sequences of the three study medications in the crossover phase and received each study medication in turn for a 2-week period. Patients continued to receive the same treatment administered during the last 2-week period of the crossover phase for an additional 6 weeks in the parallel phase. Assessment of 1-second forced expiratory volume (FEV1) curves before and after dosing on the last day of each 2-week period indicated that the combination was superior to either single agent in peak effect and area under the curve up to 8 h after dosing (FEV1-AUC0–8), in both phases of the trial. The use of Dey combination during the crossover phase resulted in 24% more improvement in peak FEV1 than was seen with albuterol alone (p < 0.001), and 37% more than was seen with ipratropium alone (p < 0.001). Similarly, when examining FEV1-AUC0–8, Dey combination resulted in 30% more improvement than was seen with albuterol alone (p < 0.001), and 32% more than was seen with ipratropium alone (p < 0.001). The combination affords a convenient dosing regimen and incorporates enhanced benefit without compromising the safety profile of either component agent.
Hyposensitization Attenuates Airway Inflammation and Antigen-Induced Proliferative Response by Lymphocytes in a Rat Model of Bronchial Asthma
Authors: Ohnuma N. , Yamaguchi E. , Oguri M. , Kawakami Y.
Published: April 2003

The mechanism of hyposensitization in bronchial asthma has not been fully elucidated. We established a hyposensitization model of bronchial asthma in rats and examined airway responses and immunological parameters. Brown Norway rats were sensitized by a subcutaneous injection of ovalbumin (OA) at day 1 and by the inhalation of 2% OA aerosol at day 15. Animals were hyposensitized by intraperitoneal injections of OA from day 17 to day 22. They were challenged with OA or acethylcholine (Ach) aerosol at day 23 and changes in intratracheal pressure were recorded. Lungs were lavaged and OA-induced proliferative responses by blood lymphocytes were examined for animals without aerosol challenge at day 23. OA-specific serum IgE levels were measured by enzyme-linked immunosorbent assay. Hyposensitization significantly reduced the OA-induced immediate airway response, accumulation of CD4+ lymphocytes and eosinophils recovered by bronchoalveolar lavage, and the OA-induced proliferative response by blood lymphocytes. The airway responses to Ach and serum OA-specific IgE levels in hyposensitized group were not significantly different from those in the sensitized group. These results indicate that amelioration of airway inflammation and hyporesponsiveness of lymphocytes against OA are involved in the attenuated immediate antigen-induced airway response following hyposensitization.
Solitary Bronchioloalveolar Adenoma of the Lung
Authors: Shiota Yutaro , Matsumoto Hitomi , Sasaki Naomi , Taniyama Kiyomi , Hashimoto Shuichi , Sueishi Katsuo
Published: April 2003

A case of an unusual pulmonary neoplasia, called bronchioloalveolar adenoma of the lung, is reported. The neoplasm presented as a solitary peripheral lesion of the left lung on computed tomography. Examination of the tumor revealed a focal proliferating lesion consisting of cuboidal or peg-shaped epithelial cells with slight nuclear atypia. Immunohistochemical study with anti-carcinoembryonic antigen antibody, anti-surfactant apoprotein antibody, and anti-Clara cell antibody suggested that this neoplasia has the characteristics of a type II pneumocyte. It is likely that more of these small peripheral lesions, which have potential for evolution to carcinoma, will now be encountered due to the introduction of helical CT of the chest.
Long-Term Remission after Brachytherapy with External Irradiation for Locally Advanced Lung Cancer
Authors: Yokomise H. , Nishimura Y. , Fukuse T. , Hirata T. , Ike O. , Mizuno H. , Wada H. , Hitomi S.
Published: April 2003

Three cases are reported who received brachytherapy with external irradiation for inoperable lung cancer and have shown long-term remission. The diseases were adenoid cystic carcinoma, recurrent adenocarcinoma and squamous cell carcinoma. The associated symptoms were severe cough and dyspnea in all 3 cases. They received 60 Gy of external irradiation. After an interval of 2 weeks, 6 Gy at a radius of 1 cm from the center of the source was delivered by iridium-192. They received 2–4 fractions at 1-week intervals. On termination of brachytherapy, complete response was observed in all cases. In 1 case, bronchial stenosis due to radiation-induced fibrosis was observed, but was successfully treated by bronchial stent. Cough and dyspnea disappeared, and all patients have been rendered asymptomatic for the last 2 years. Local disease was well controlled in 2 cases; however, minimal local recurrence was observed after a 2-year follow-up in 1 case.
Recurrent Chest Opacities in a Patient with Thromboembolic Pulmonary Hypertension
Authors: Wakamatsu Kentaro , Inoue Hiromasa , Aizawa Hisamichi , Mitsuyama Takashi , Tsuda Hiroko , Hara Nobuyuki
Published: April 2003

We describe a 42-year-old man with chronic thromboembolic pulmonary hypertension associated with protein S deficiency. He presented with unusual roentgenographic findings of migratory pulmonary infiltrates.
Selection of Reproducible Forced Expirograms: Percentage or Fixed-Volume Criterion
Authors: Pistelli Francesco , DiPede Francesco , Viegi Giovanni , Carrozzi Laura , Pistelli Giuseppe , Giuntini Carlo
Published: April 2003

The aim of this study was to evaluate whether the intrasession reproducibility of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) depends on height and lung volume. FVC tracings of 740 subjects (350 males) from a general population sample living in North Italy were analyzed. Subjects filled out a standardized questionnaire and performed three acceptable FVC maneuvers following the American Thoracic Society recommendations. The differences between the largest and the second largest FVC and FEV1 were computed as absolute (ΔFVC, ΔFEV1) and as percentage values (ΔFVC%, ΔFEV1%). The higher the tertiles of the largest FVC and FEV1 were, the higher were ΔFVC and ΔFEV1. Regarding FVC, borderline differences in both sexes for ΔFVC and in males significant differences for ΔFVC% were found among the tertiles. Regarding FEV1, in both sexes ΔFEV1 significantly differed among the tertiles. ΔFVC and ΔFEV1 correlated with height and lung volume in both sexes, except for ΔFVC versus the largest FVC in females. When ΔFVC and ΔFEV1 were analyzed with respect to respiratory symptoms/diseases and smoking habit, no significant differences were observed in both sexes, except for ΔFEV1 between ever- and never-smoking males. It may be concluded that the intrasession within-subject variability of FVC and FEV1 is proportional to lung volume and height, regardless of the sex, presence of symptoms and smoking habit. Thus, our results confirm the usefulness of a reproducibility criterion based on a percentage rather than on a fixed volume.
Hemoglobin SC Disease Presenting as Acute Chest Syndrome with Ventilation-Perfusion Mismatches
Authors: Noto Hiroshi
Published: April 2003

Acute chest syndrome, characterized by fever, chest pain and pulmonary infiltrates, is a known complication of hemoglobin SC disease. A 41-year-old African male with previously unknown hemoglobinopathy developed an acute episode of fever, chest pain and dyspnea right after surgery for retinal detachment. The patient was suspected of having pulmonary thromboembolism. This was further suggested by a ‘high probability’ ventilation-perfusion scan. However, a pulmonary angiogram revealed no evidence of thromboembolism. Subsequently, the patient was recognized to have hemoglobin SC disease, with the acute chest syndrome. After appropriate treatment with antibiotics, hydration and exchange transfusion, the patient underwent another surgery without complications.
Metastatic Pulmonary Epithelioid Hemangioendothelioma with Peculiar Radiographic Features
Authors: Nagata Nobuhiko , Takatsu Hiroyuki , Sato Yoshiya , Yoshimatsu Takashi , Urabe Michita , Kido Masamitsu
Published: April 2003

We report a case of a pulmonary epithelioid hemangioendothelioma presenting as a solitary pulmonary nodule with subsequent systemic spread, including histologically documented gingival metastasis. Chest radiography and computed tomography at initial evaluation showed a solitary 2 cm pulmonary nodule, associated with pleural indentation and vascular convergence. The tumor later spread systemically, including multiple pulmonary nodules, bilateral pleural effusions, and gingival swelling and erosion. A biopsy of the gingival lesion showed histologic features identical to that of the lung biopsy.
Severe Barium Sulfate Aspirationinto the Lung: Clinical Presentation, Prognosis and Therapy
Authors: Tamm Ingo , Kortsik Cornelius
Published: April 2003

Aspiration of large amounts of barium sulfate is a rare incident during radiographic contrast procedures. Here we describe two patients, who developed acute dyspnea after aspiration of significant amounts of barium into the lung during an upper gastrointestinal radiographic contrast study. The regions of the lung involved depended on the position of the patients during and after aspiration. Arterial blood gas analysis revealed hypoxemia due to alveolar shunt with V/Q distribution disturbances. Bronchoscopy was performed to extract the contrast medium from the tracheobronchial tree. The patients could be discharged a few days later with normal lung function. Long-term prognosis is generally excellent due to the inert character of barium sulfate, even though impressive radiographic findings remain.
Hemodynamic Effects of Bilevel Nasal Positive Airway Pressure Ventilation in Patients with Heart Failure
Authors: Philip-Joët François F. , Paganelli Franck F. , Dutau Hervé L. , Saadjian AlainY.
Published: April 2003

Aims: Benefits of nasal continuous positive airway pressure (CPAP) in patients presenting with chronic heart failure (CHF) are controversial. The purpose of this study was to compare the hemodynamic effects of CPAP and bilevel positive airway pressure (BiPAP) in patients with or without CHF. Methods and Results: Twenty patients with CHF and 7 with normal left ventricular function underwent cardiac catheterization. Measurements were made before and after three 20-min periods of BiPAP: expiratory positive airway pressure (EPAP) = 8 cm H2O and inspiratory positive airway pressure (IPAP) = 12 cm H2O, EPAP = 10 cm H2O and IPAP = 15 cm H2O, and CPAP = EPAP = IPAP = 10 cm H2O administered in random order. Positive pressure ventilation decreased cardiac output (CO) and stroke volume. No change was observed in either pulmonary or systemic arterial pressure. There was no difference in the hemodynamic effects of the three ventilation settings. Only mean pulmonary wedge pressure (MPWP) and heart rate were lower with CPAP than with BiPAP. CO decreased only in patients with low MPWP (≤12 mm Hg). BiPAP ventilation increased PaO2 and decreased PaCO2 more than CPAP. Conclusions: In patients with cardiac failure, a decrease in CO occurs both during CPAP and BiPAP, when pulmonary wedge pressure is low (≤12 mm Hg).
Subchronic Exposure to Diisocyanates Increases Guinea Pig Tracheal Smooth Muscle Responses to Acetylcholine
Authors: Marek W. , Potthast J. , Marczynski B. , Mensing T. , Baur X.
Published: April 2003

Objective: In order to study the threshold concentrations of isocyanates (IC) for induction of lung disorders, constrictive responses of tracheal smooth muscles to acetylcholine (ACH) in guinea pigs with and without diisocyanate [toluene diisocyanate (TDI), hexamethylene diisocyanate (HDI) and diphenylmethane diisocyanate (MDI)] exposure were investigated. Methods: An IC-induced increase in smooth muscle responsiveness was studied by measuring cumulative ACH dose responses (10–10 to 10–4 M ACH). Basal ACH dose-response curves, measured twice in intervals of 1 h using tracheal preparations of 11 guinea pigs previously not exposed to IC, were reproducible. Results: Subchronic in vivo exposures to TDI, HDI, and MDI atmospheres of 10 and 20 parts per billion (ppb) on 5 consecutive days led to significantly (p < 0.05) increased ACH responsiveness of tracheal smooth muscle, whereas concentrations of 2.5 and 5 ppb were not effective. Exposure to HDI atmospheres of 10 ppb for 1, 2, 4, or 8 weeks resulted in a time-dependent increase in ACH responses (p < 0.05) of guinea pig tracheal smooth muscle. Increased tracheal muscle responses to ACH were transient since tracheal preparations from animals exposed to 10 and 20 ppb MDI for 4 weeks and with an exposure-free interval of 8 weeks before preparation did not show enlarged ACH responses, which were present in preparations at the end of the exposure period (p < 0.05). Exposure to low IC concentrations as present in workplaces cause increased ACH responsiveness of guinea pig tracheal smooth muscle. The increased responsiveness of the airways seems to be largely reversible, since normal responses were found after 8 weeks of IC avoidance. Conclusion: Reversibility of IC-induced airway hyperresponsiveness is of great occupational and preventive medical importance. Workers with acquired airway hyperresponsiveness might escape lung damage if the changes are detected in an early stage before alterations in lung function are in a chronic stage.
Severe Muscle Weakness due to Hypokalemia as a Manifestation of Small-Cell Carcinoma
Authors: Konstantinidis Athanasios , Elisaf Moses , Panteli Katerina , Constantopoulos Stavros
Published: April 2003

We describe the case of a 56-year-old man with severe muscle weakness due to heavy hypokalemia (serum potassium 1.44 mmol/l) associated with inappropriate kaliuria and alkalemia. Subsequent investigation revealed the presence of ectopic ACTH hypersecretion due to a small-cell lung carcinoma. A significant clinical/laboratory improvement was achieved following chemotherapy-induced regression of the primary tumor. The profound hypokalemia was probably the result of cortisol hypersecretion, which in concert with the ACTH-induced decreased 11β-hydroxysteroid dehydrogenase activity can exhibit an increased mineralocorticoid activity. In addition, other ACTH-dependent mineralocorticoids may play a contributory role in the development of severe hypokalemia.
Pulmonary Malignancies in the Immunocompromised Patient
Authors: Cadranel Jacques , Naccache Jean-Marc , Wislez Marie , Mayaud Charles
Published: April 2003

Clinicians should be familiar with immunodeficiency-related malignancies, as their incidence is expected to increase further with the rise in the number and survival of immunocompromised patients. The most common malignancies affecting the lungs in those patients are Kaposi’s sarcoma, non-Hodgkin’s lymphoma and, to a far less extent, Hodgkin’s disease and bronchogenic carcinoma. However, their relative frequency depends on the types of immune deficiency, including those due to congenital disorders, AIDS and drug treatments. This review will summarize epidemiological data on the frequency of immmunodeficiency-related malignancies, recent advances on their pathogenesis and current approaches to their diagnosis and treatment in the various immunosuppressed groups.
Reliability of Thoracic Gas Volume Derived from Mechanical Impedance at Different Levels of the Vital Capacity
Authors: Peslin R. , Duvivier C.
Published: April 2003

Background: Thoracic gas volume (TGV) may be estimated during spontaneous breathing by measuring simultaneously respiratory impedance (Zrs) and alveolar gas compression (Vpl) at several oscillation frequencies [Peslin and Duvivier: J Appl Physiol 1998;84:862–867]. Objective: The aim of the study was to test the validity of that approach at different levels of the vital capacity (VC). Methods: We measured Zrs and Vpl at frequencies ranging from 6 to 29 Hz in 10 healthy subjects rebreathing BTPS gas in a constant volume body plethysmograph. In a first series, the subjects were asked to breathe voluntarily at different levels of the VC and oscillation TGV (TGVos) was compared to standard plethysmographic TGV (TGVst) assessed immediately after TGVos measurements. In a second series, the subjects were asked to change stepwise their lung volume in the middle of the forced oscillation recording, and the changes in TGVos (ΔTGVos) were compared to the changes in lung volume (ΔV) computed from the integrated flow signal. Results: In most subjects TGVos and TGVst were highly correlated and the slopes of the relationships did not differ significantly from unity. ΔTGVos and ΔV were also highly correlated both in individuals and in the group (r = 0.97), and their signless differences averaged 0.23 ± 0.20 liter. Conclusion: We conclude that forced oscillation estimates of TGV are reliable in healthy subjects over a large part of the VC.
Both Inhaled Histamine and Hypertonic Saline Increase Airway Reactivity in Non-Sensitised Rabbits1
Authors: Högman Marieann , Hjoberg Josephine , Almirall José , Hedenstierna Göran
Published: April 2003

Background: Asthmatics react with bronchoconstriction upon a variety of stimuli, i.e. exercise and hypertonic aerosol challenge. We have previously shown that hyperventilation with dry gas in a rabbit model resulted in a change of the ion content of the tracheal wall. This was followed by a hyperreactive response to histamine. Objective: We hypothesised that nebulisation with 3.6% hypertonic saline will be accompanied by a hyperreactive response to histamine in a rabbit model. Methods: Anaesthetised rabbits were given histamine after nebulisation with hypertonic saline. In addition, repeat nebulisation with hypertonic saline was given with or without histamine between these nebulisations. Results: There was a different response to histamine 10 mg·ml–1 whether hypertonic saline had been given or not (p < 0.001). Histamine nebulisation, given after hypertonic saline, caused an increase from baseline in resistance of 65 ± 12 cm H2O·litre–1·s (mean ± SEM, p < 0.001) and a decrease in compliance of 2.3 ± 0.4 ml·cm H2O–1 (p < 0.001). The corresponding values for the control animals were 10 ± 4 cm H2O·litre–1·s (n.s.) and 1.7 ± 0.2 ml·cm H2O–1 (p < 0.001). At a second nebulisation with hypertonic saline, with a histamine challenge 30 min before, the resistance increased from baseline by 35 ± 10 cm H2O·litre–1·s (p < 0.01). This was not observed when no histamine had been given between the hypertonic saline nebulisations. Conclusions: This study in rabbits shows that hypertonic solutions cause an increase in the responsiveness to histamine and that histamine causes an increase in responsiveness to hypertonic saline. This is similar to the response of asthmatics to hypertonic saline.
Effect of Nitric Oxide Synthase Inhibition on Hemoglobin-Oxygen Affinity and Lipid Peroxidation in Rabbits during Fever
Authors: Zinchuk Victor
Published: April 2003

Background: Nitric oxide (NO) is one of the most important biologic messengers and takes part in the development of fever. It can influence on the body prooxidant-antioxidant balance by different ways including interaction with hemoglobin (Hb). Methods: The effects of nitric oxide synthesis inhibition on the febrile response, hemoglobin-oxygen affinity and parameters of lipid peroxidation were studied in rabbits with fever. The fever was induced by intravenous administration of lipopolysaccharide from Salmonella typhi (0.6 μg/kg). Mixed venous blood was taken before the administration and 60, 120 and 180 min after it. The following parameters were measured: half-saturation oxygen pressure (P50), concentrations of conjugated dienes, Schiff bases and α-tocopherol in plasma and red blood cells, and activity of catalase in red blood cells. Results: The intravenous administration of the nitric oxide synthase inhibitor (Nω-nitro-L-arginine; 5·10–3 M) reduced the lipopolysaccharide-induced rise in body temperature. After 180 min the actual P50 had decreased from 35.0 ± 1.7 to 29.4 ± 1.3 mm Hg. An increase in the lipid peroxidation parameters and a decrease of the antioxidant system indices were observed. The administration of L-arginine to prevent nitric oxide synthase inhibition was accompanied by a shift of the oxyhemoglobin dissociation curve rightwards, more marked activation of the free radical processes and a greater elevation of body temperature. The multiple regression analysis showed a close linear correlation between P50 and conjugated dienes, Schiff bases, α-tocopherol and catalase. Conclusion: These results suggest that the increased hemoglobin-oxygen affinity found after the inhibition of nitric oxide synthesis lowers the oxygen flow to tissues and its fraction utilized in free radical oxidations, which finally causes a reduction of the fever response to the lipopolysaccharide.
Chronic Cough due to Bronchobiliary Fistula
Authors: AL-Mezem Saleh S. , AL-Jahdali Hamdan H.
Published: April 2003

Bronchobiliary fistula is a rare cause of chronic cough. Here we describe a 70-year-old woman complaining of chronic cough and copious dark-yellow watery sputum. The presence of air in the biliary tract in the lower cuts of a computerized tomography scan of the chest and positive bile in the sputum led to the suspicion of bronchobiliary fistula. The diagnosis was confirmed by percutaneous transhepatic cholangiography. Drainage of the intrahepatic biliary tract resulted in complete resolution of her symptoms.
Noninfectious Lung Disease in the Immunocompromised Host
Authors: Crawford Stephen W.
Published: April 2003

Patients with compromised immune function suffer a wide variety of lung insults. Infections are the most common causes of both acute and chronic lung diseases, but many noninfectious conditions affect the lungs. The clinical presentation of these noninfectious conditions often mimic infections, thus causing diagnostic dilemmas. The spectrum of noninfectious lung injury and response in the immunosuppressed host includes interstitial edema, interstitial fibrosis, diffuse idiopathic pneumonia, acute respiratory distress syndrome, and obliterative bronchiolitis. Alveolar hemorrhage may complicate any of these conditions. Lung injury in the immunosuppressed host is associated with a diversity of etiologies: sepsis, irradiation, graft rejection, reperfusion injury, graft-versus-host disease, and chemotherapeutic agents and other drug reactions. These injuries most often present as diffuse pulmonary infiltrates on chest radiograph. Establishing a specific diagnosis and etiology for the injury is often problematic. From a pragmatic standpoint, excluding the possibility of infection is the principal aim of diagnostic testing.
Blood Gases and Sex Hormones in Women with and without Genital Descensus
Authors: Eterović Davor , Strinić Tomislav , Dujić Željko , Boban Mladen
Published: April 2003

Background: Abnormalities in connective tissue and spirometric disorders have previously been found in women with genital descensus. Objective: To evaluate the association of descensus and respiratory function. Methods: The blood gases and sex hormones were measured in 130 women scheduled for surgical correction of descensus and 60 matched women without descensus. All subjects were nonsmokers and without past or present cardiorespiratory disease. Results: Women with descensus had a lower pH (7.39 ± 0.04 vs. 7.41 ± 0.04, p = 0.01), lower arterial tensions of oxygen (12.7 ± 12. vs. 14.1 ± 0.9 kPa, p = 0.003) and carbon dioxide (5.1 ± 0.4 vs. 5.3 ± 0.3 kPa) but a higher hemoglobin concentration (141 ± 11 vs. 132 ± 9 g/l) and a higher serum progesterone in the follicular phase of the cycle (3.1 ± 4 vs. 1.5 ± 1 ng/ml, p = 0.03). In 39 (30%) women with descensus, the arterial carbon dioxide tension was below 4.9 kPa. All subjects ventilated more in the luteal compared to the follicular phase of the cycle. In women with descensus, the hemoglobin concentration increased with decreasing arterial oxygen tension (p = 10–4) and with decreasing pH (p < 10–3). Conclusion: Women with descensus frequently hyperventilate and, compared with women without descensus, have a lower arterial oxygen tension, increased hemoglobin concentration and slightly lower pH.
Effects of Weight Loss on Body Composition and Pulmonary Function
Authors: De Lorenzo Antonino , Petrone-De Luca Patrizia , Sasso Guido F. , Carbonelli Maria G. , Rossi Paolo , Brancati Aldo
Published: April 2003

Background: The relationship between obesity, impaired respiratory function and weight loss is established. Objective: Some aspects need further elucidation: the different impact of the pathological modifications of body compartments (total and regional fat mass and lean body mass) on respiratory function, the choice of a restricted diet, the relationship between the modifications of body compartments and the variations in respiratory parameters after weight loss. Methods: The restricted diet was elaborated according to the traditional Mediterranean diet. In a series of 16 obese patients, respiratory function was assessed by spirometry; body composition was assessed by dual-energy X-ray absorptiometry, allowing the direct estimation of total and segmental body fat and lean body mass. Results: Weight loss was sustained mainly by fat mass decrease, mostly upper body fat. Total and truncal lean body mass were not affected. Lung volumes and function were improved. A correlation was observed between lean body mass and respiratory parameters, and was unmodified after weight loss. Conclusions: Mediterranean-style restricted diet was well accepted and enabled a selective decrease in fat mass, with a good improvement in lung function. Truncal fat (as well as abdominal fat) was decreased, while truncal lean body mass (i.e. respiratory muscles) were not affected, as expected in obese subjects with respiration problems.
Treatment of Community-Acquired Pneumonia in Outpatients: Randomized Study of Clarithromycin Alone versus Clarithromycin and Cefuroxime
Authors: Rovira E. , Martínez-Moragón E. , Belda A. , Gonzalvo F. , Ripollés F. , Pascual J.M.
Published: April 2003

Objective: To evaluate the efficacy of clarithromycin alone in comparison with the combination of clarithromycin and cefuroxime in the treatment of nonhospitalized patients with community-acquired pneumonia (CAP) in a Mediterranean population. Methods: CAP was defined as the acute onset of fever (>38°C) with pulmonary opacity on chest roentgenogram. The American Thoracic Society (ATS) criteria (1993) were used to decide on patient hospitalization. Ninety subjects, of whom 53 (59%) were men, with a mean age (± SD) of 38 ± 15 years, were randomized: 45 received clarithromycin 500 mg b.i.d. orally for 14 days (CL group), and 45 received clarithromycin plus cefuroxime 500 mg b.i.d. orally for 7 days (CLCE group). Patients were monitored with clinical, radiological, and laboratory controls at 3 and 21 days. There were no significant differences between the two groups with regard to demographic, clinical, physical and laboratory data. Results: The mean time to defervescence was 2.4 ± 1.4 and 2.4 ± 1.5 days, respectively. Chest roentgenogram clearance was complete in all cases, without statistically significant differences in the time to resolution between both arms. Side effects were mild (no significant differences between groups): 5 patients in the CL group and 3 in the CLCE group showed gastrointestinal symptoms. Two patients (2.2%), both in the CLCE group, needed hospital admission during follow-up, but all 90 patients showed an excellent outcome. A causative agent was determined in 25 cases (28%). Legionella pneumophila, Streptococcus pneumoniae, and Mycoplasma pneumoniae were the most frequent pathogens. Conclusion: Empirical treatment of outpatient CAP with clarithromycin can be considered adequate in the Mediterranean area, independently of the microbiological etiology. ATS criteria for admitting patients with CAP are appropriate in this population.
Proinflammatory or Regulatory Cytokines Released from BALF Macrophages of Healthy Smokers
Authors: Mikuniya Takeshi , Nagai Sonoko , Tsutsumi Takeo , Morita Koji , Mio Tadashi , Satake Norio , Izumi Takateru
Published: April 2003

Background: Chronic smoking influences bronchoalveolar lavage fluid (BALF) cell profiles in healthy subjects, which may alter profiles of inflammatory and regulatory cytokines. Objective: We focused on the evaluation of smoking-related changes in the amounts of cytokines released from BALF macrophages. Methods: We measured the amounts of immunoreactive culture supernatants by using ELISA. Results: The amounts of IL-1 receptor antagonist (IL-1ra) were lower in smokers [n = 10, median 22.1 ng/ml, 25th and 75th percentiles (18.7–39.1)] than in nonsmokers [n = 10, 48.6 (39.2–66.1), p = 0.010]. In smokers, lipopolysaccharide stimulation revealed decreases in the amounts of interleukin-6 (IL-6) [nonsmokers: 2.1 ng/ml (0.68–5.4 vs. smokers: 0.5 (0.03–0.87), p = 0.049] as well as IL-1ra [nonsmokers: 69.2 ng/ml (48.3– 83.8) vs. smokers: 27.3 (17.2–56.7), p = 0.028]. A delay in release from intracellular storage was not the cause of the reduced amounts of IL-1ra. In addition, interleukin-1β (IL-1β) was positively correlated with IL-6 and granulocyte macrophage colony-stimulating factor in nonsmokers, but not in smokers. Furthermore, the decreases in IL-1ra and interleukin-8 were correlated with the increase in the number of BALF macrophages in smokers, but not in nonsmokers. Conclusions: Chronic smoking caused changes in the profiles of cytokines released from BALF macrophages in healthy subjects. Decreases in the amounts of regulatory cytokines, but not prominent changes in the amounts of inflammatory ones, were characteristic.
Effect of Inhaled Glutathione on Airway Response to ‘Fog’ Challenge in Asthmatic Patients
Authors: Bagnato G.F. , Gulli S. , De Pasquale R. , Giacobbe O. , Spatari G. , Purello D’Ambrosio F.
Published: April 2003

Objective: We report on the effect of glutathione, an antioxidant compound on the airway response to the ultrasonically nebulised distilled water (UNDW, ‘fog’) challenge. Methods: 12 subjects with mild-to-moderate bronchial asthma underwent double-blind, cross-over pretreatment, administered 30 min earlier, in a randomised order with inhaled glutathione (G) (600 mg), sodium cromoglycate (SCG) (20 mg) and placebo (P), followed by the challenge. Results: After P pretreatment UNDW challenge caused a mean 20.41% decrease in FEV-1 (p < 0.05), after G, a mean 6.04% fall in FEV-1 (p = n.s.), and after SCG a mean 5.99% fall in FEV-1 (p = n.s.). Conclusions: G significantly attenuated ‘fog’-induced falls in FEV-1 (p < 0.001 compared with P) and showed a protective effect on UNDW-induced bronchoconstriction.
Lung Cancer Associated with Pulmonary Bulla
Authors: Ogawa Daisuke , Shiota Yutaro , Marukawa Masaomi , Hiyama Junichiro , Mashiba Hiroto , Yunoki Keiji , Imai Shigeo , Motohiro Katsumi , Sasaki Naomi , Taniyama Kiyomi
Published: April 2003

A few reports have suggested the possible association between lung cancer and bullous disease. We report a surgical case of lung adenocarcinoma located in close proximity to pulmonary bullae. A 48-year-old nonsmoker, asymptomatic male was found to have a pulmonary tumor mass and giant bulla in the right lung. Thoracotomy identified a tumor arising from a firm, scarred and contracted area close to the bulla wall. Based on this report and review of other cases in the literature, we emphasize the need for physicians to be aware of the potential development of lung cancer in patients with pulmonary bulla.
Pathogenesis of Lung Disease in Cystic Fibrosis
Authors: Dinwiddie R.
Published: April 2003

Lung disease in cystic fibrosis is primarily due to a defect in the cystic fibrosis transmembrane regulating protein (CFTR). This results in abnormal chloride transfer across epithelial membranes causing an excessively viscid mucus lining of the airways. Bacterial invasion particularly with Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa stimulates a vigorous and excessive primarily neutrophil-driven inflammatory response throughout the lungs. Products of this inflammation not only damage incoming bacteria but also the host tissue itself. Over a period of years this chronic suppurative process results in permanent ongoing lung destruction principally manifested as bilateral bronchiectasis.
Quality of Life and Economic Features in Elderly Asthmatics
Authors: Plaza Vicente , Serra-Batlles Joan , Ferrer Montserrat , Morejón Elena
Published: April 2003

Background: In the geriatric population, asthma tends to be overlooked. Moreover, typical symptoms of asthma may mimic chronic bronchitis and emphysema. Objective: To compare the characteristics of asthma between elderly (≥65 years) and adult (<65 years) asthma patients with regard to asthma severity, health-related quality of life, and direct expenditures for medical care generated by the disease. Methods: A cross-sectional study was made in the asthmatic population older than 14 years in the area of Barcelona, Spain. Asthma severity was determined according to the International Consensus criteria of 1992. St. George’s Respiratory Questionnaire (SGRQ) was used to measure the quality of life. Direct costs were calculated registering all costs generated by each patient per year. Results: The study population consisted of 282 adult asthmatics and 51 elderly asthmatics. Asthma was more severe in the elderly group (mild 10%, moderate 35%, severe 55%) than in the adult group (mild 47%, moderate 35%, severe 18%). Elderly asthmatics had significantly higher total SGRQ scores (48 vs. 35, p < 0.001) than adult asthmatics, as well as significantly higher scores for all subscales. Asthma-derived direct costs in elderly asthmatics (mean USD 1,490 vs. USD 773) were double those in adult asthmatics, mainly due to higher costs of hospitalization and medication in the elderly. Conclusions: Asthma in elderly people as compared with asthma in adulthood was more severe and was associated with a worse health-related quality of life, and significantly higher expenditures for medical care.
Inhaled Corticosteroids May Reduce Neutrophilic Inflammation in Patients with Stable Chronic Obstructive Pulmonary Disease
Authors: Yildiz F. , Kaur A.C. , Ilgazlı A. , Celikoglu M. , Kaçar Özkara S. , Paksoy N. , Özkarakaş O.
Published: April 2003

Background: Although both inhaled and oral corticosteroids have anti-inflammatory effects causing improvement in clinical symptoms and spirometry in the treatment of asthma, the role of corticosteroids in the management of chronic obstructive pulmonary disease (COPD) is controversial. Objective: To evaluate the effects of inhaled corticosteroids on sputum neutrophilia in clinically stable COPD patients. Methods: In total, 18 patients were enrolled in the study. During 2 months, 9 patients in group A inhaled fluticasone propionate (FP) 500 μg 3 times daily. In group B 9 patients received placebo. All of the patients continued to inhale both salbutamol and ipratropium bromide. In 9 patients, sustained-released theophylline was also administered. Blood samples, spirometric tests, blood gas analyses, and either spontaneous or induced sputum cultures were evaluated on entry into the study, after a 2 months of treatment and following the 6-week washout period. Results: After the 2-month FP treatment, no significant changes in the number of peripheral blood neutrophils, blood gas and spirometry data were observed in both groups. In group A, the total cell number and the number of neutrophils decreased from a mean of 3.4 ± 1.3 × 106 cells/g and 0.6 ± 0.3 × 106 neutrophils/g on entry into study to 1.9 ± 0.6 × 106 cells/g and 0.02 ± 0.01 × 106 neutrophils/g after 8-week treatment with FP, returning to 3.3 ± 1.1 × 106 cells/g and 0.5 ± 0.3 × 106 neutrophils/g following the washout period. The percentages of neutrophils were 55.6 and 77.9% in groups A and B after 2 months of FP treatment. There was no significant change in group B values during the study. Conclusion: These data suggest that neutrophilic inflammation in sputum may be decreased by inhaled corticosteroids in clinically stable COPD patients.
Immediate Intraoral Adaptation of Mandibular Advancing Appliances of Thermoplastic Material for the Treatment of Obstructive Sleep Apnea
Authors: Schönhofer B. , Hochban W. , Vieregge H.J. , Brünig H. , Köhler D.
Published: April 2003

Background: In the treatment of obstructive sleep apnea (OSA), mandibular advancing devices (MAD) are usually individually fabricated on plaster casts of both jaws from polymethyl-methacrylate. The potential disadvantages of these devices are (1) the costs and (2) the time required to construct the device. Objective: In this study, the efficacy and feasibility of a cheap MAD consisting of thermoplastic material (SnorBan®), which can be directly moulded intraorally, were evaluated. Methods: In a prospective study, the effect of an MAD consisting of thermoplastic material was investigated in 22 consecutive patients with OSA [respiratory disturbance index (RDI) 32.6 ± 18.4/h]. Polysomnographic sleep was recorded prior to treatment and after 3 months of treatment with the MAD. Results: Three of the 22 patients who did not tolerate the MAD were excluded from the analysis, whereas 11 patients were classified as responders. In the responder group, the mean RDI decreased from 27.6 ±7.3 to 7.3 ± 2.9 (p < 0.01), correspondingly the sleep quality and the Epworth Sleepiness Scale improved (p < 0.05). Eight patients proved to be non-responders without relevant changes for the measured parameters. Conclusions: In 50% (11 of 22) of the patients, the MAD improved the OSA to a clinically relevant degree. In contrast to the majority of established MAD, the MAD investigated is cheap and immediately adaptable and thus a feasible strategy to ‘screen’ the efficacy of this therapeutic principle. Thus the construction of unnecessary MAD is avoided.
Trepopnea due to Recurrent Lung Cancer
Authors: Tsunezuka Yoshio , Sato Hideo , Tsukioka Toshihide , Shimizu Hiroshi
Published: April 2003

Trepopnea is a condition whereby breathing may be comfortable in one position but difficult or labored in another. A unique case with trepopnea due to recurrent lung cancer with right main pulmonary artery stenosis and left main bronchus obstruction is presented. The patient had developed trepopnea 3 months earlier, but developed orthopnea shortly before he was admitted to our hospital. An emergent wall stent implantation was performed via the right femoral vein in the sitting position with the patient’s leg stretched out. The symptoms and respiratory function improved after stent implantation.
Effect of Intravenous Fructose 1,6-Diphosphate Administration in Malnourished Chronic Obstructive Pulmonary Disease Patients with Chronic Respiratory Failure
Authors: Marchesani Francesca , Valerio Giuseppe , Dardes Nicola , Viglianti Bruno , Sanguinetti Claudio M.
Published: April 2003

Background: Weight loss and skeletal muscle wasting are common in patients with chronic obstructive pulmonary disease (COPD) and can influence the course and the prognosis of COPD. Hypophosphatemia is a pathologic status often characterized by muscle weakness and is a frequent laboratory finding in these patients. Objective: The aim of the present study was to evaluate the effect of an organic phosphate (fructose 1,6-diphosphate, FDP) administration on respiratory performance in 45 malnourished COPD patients in stable clinical conditions. Methods: Physiologic evaluation including spirometry, maximal voluntary ventilation (MMV), elevated arm test, maximal mouth pressures (PImax and PEmax), respiratory response to CO2, oxygen (PaO2) and carbon dioxide (PaCO2) arterial tension, a visual analogic scale (VAS) to measure dyspnea, and complete blood tests were done at the beginning and again at the end of the study. Results: After FDP administration, there was a significant increase in PImax (43.0 ± 18.3 cm H2O before treatment vs. 49.8 ± 14.9 cm H2O after treatment; p < 0.005). This did not occur in the placebo group (40.3 ± 17.4 cm H2O before treatment vs. 42.6 ± 20.1 cm H2O after treatment, nonsignificant). There was also a trend of VAS to decrease and of MVV to increase. Conclusions: These results show that FDP administration may be useful in the management of malnourished COPD patients, especially in increasing their respiratory muscle strength.
Immunohistochemically Stained Activated Eosinophils in Sputum in Patients with Asthma
Authors: Jang An-Soo , Choi Inseon-S , Park Chang-Soo
Published: April 2003

Background: Eosinophils play an important role in asthmatic airway inflammation. Monoclonal antibody EG2 has been considered to identify activated eosinophils. Objective: The present study was aimed to investigate whether immunohistochemically stained EG2+ eosinophils in sputum reflect the severity of asthma. Methods: Sputum was obtained in 23 asthmatic patients, of whom 13 patients were examined before and after antiasthma treatment including steroid preparations. We used immunohistochemical staining to detect EG2+ (activation marker) eosinophils and fluoroimmunoassay to detect eosinophil cationic protein (ECP). Results: Moderate to severe asthmatics had a significantly higher proportion of eosinophils and EG2+ eosinophils and higher levels of ECP compared to mild asthmatics (40.9 ± 5.8 vs. 6.4 ± 1.2%, 35.5 ± 5.6 vs. 2.7 ± 1.0%, 1.470.2 ± 251.5 vs. 210.6 ± 52.0 μg/l, respectively; p < 0.01). Significant increases in proportions of eosinophils, EG2+ eosinophils and ECP in the sputum from patients with exacerbated asthma were evident. The proportions of eosinophils, EG2+ eosinophils, and the levels of ECP were reduced following treatment with antiasthmatic drugs. FEV1 and FEV1/FVC were significantly correlated with EG2+ eosinophils. Conclusion: These findings demonstrate that EG2+ eosinophils in sputum are closely related to the clinical status in patients with asthma.
Takayasu Disease with Predominant Pulmonary Involvement
Authors: Elsasser Serge , Solèr Markus , Bolliger Chris T. , Jäger Kurt , Steiger Ulrich , Perruchoud André P.
Published: April 2003

We report a case of Takayasu’s arteritis with predominant pulmonary involvement, which led eventually to complete obliteration of the right pulmonary artery. Subsequently, cavitation and chronic inflammation developed in the nonperfused right lung. A right pneumonectomy was performed to control the infectious process, leading to functional improvement and better control of the underlying immunologic disorder.