bluuebunny/crossref_metadata_2025 huggingface dataset:
Runner-Up Magnetron Sputtered CrNx Coatings as Alternative to Electroplated Hard Chromium
Authors: Hurkmans A. , Lewis D. B. , Münz W. D.
Published: September 2003

The coating of engineering components with electroplated hard chromium is a widely used practice. These coatings are reasonably hard (∼1000 HV) and are deposited in thicknesses of ∼20 μm, having a fine microcracked structure. Physical vapour deposition (PVD) is an alternative technique, replacing the limited performance and environmentally unfriendly electroplating process (hexavalent chromium). CrNx is the most promising PVD coating to replace electroplated hard chromium. In contrast to other PVD hard coatings, it can be deposited in thicknesses up to 50 μm and at deposition temperatures below 250°C. The unbalanced magnetron sputtering technique allows reasonably high growth rates, typically several micrometers per hour. In contrast to cathodic arc evaporation, unbalanced magnetron sputtered coatings are smooth, without the arc typical droplets. The deposition equipment used in the present study allowed a wide range of deposition parameters leading to insights in the growth of bcc Cr–N, hcp Cr2N, and fcc CrN coatings. The following modifications were observed: a fine grained solid solution bcc Cr–N (1800 HV at 18 at.-%N) with a Young's modulus similar to that of steel; an under stoichiometric hcp Cr2N phase (2200 HV at 24 at.-%N); a soft single phase stoichiometric hcp Cr2N phase (1600 HV at 33 at.-%N); the established {110} textured fcc CrN phase (1800–2000 HV) and finally, a new hard fcc CrN phase (2700–3100 HV) obtained with high bias voltages (>- 200 V) and nitrogen flow rates in excess of the argon flow. The latter coating promises excellent properties with respect to wear, friction and corrosion.
Influence of Post-treatments on Corrosion Behaviour of Gas Nitrocarburised Steels
Authors: Steyer P. , Millet J.-P. , Mazille H. , Peyre J.-P. , Jacquot P. , Hertz D.
Published: September 2003

Nitrocarburising is a thermochemical diffusion treatment involving the surface nitrogen enrichment of low alloyed steels, leading to the formation of iron carbonitrides characterised by good tribological properties. In order to make engineering components multi-functional, new processes including post-operations have been developed in the last decade but their influence on corrosion resistance is not yet fully understood. The aim of the present study is to determine the corrosion behaviour of gas nitrocarburised steel produced on both a laboratory and industrial scale. Behaviour has been evaluated by salt spray tests as well as by electrochemical techniques (corrosion potential and polarisation resistance evolutions versus immersion time, potentiodynamic curves). All nitrocarburising treatment improves the corrosion resistance compared to untreated steel. Post-oxidising treatments have no significant influence on corrosion resistance but an impregnation step appears efficient in enhancing corrosion. The carbonitrides present in the ‘white layer’ are nobler than the substrate, and promote localised corrosion through open porosity of the outlayer by a galvanic effect.
Determination of Hardness and Young's Modulus of Brush Plated Nano-AL2O3/NI Composite Coating by Nanoindentation Testing
Authors: Dong S. , Beake B. D. , Parkinson R. , Bell T.
Published: September 2003

Nanoindentation was used to produce maps of the hardness and elastic modulus through cross-sections of a brush plated nanoparticle composite n-Al2O3/Ni coating on mild carbon steel. The Young's modulus of the brush plated n-Al2O3/Ni composite coating was ∼200 GPa. The coating exhibited uniform mechanical properties throughout its thickness, with the exception of a few regions with low hardness and modulus due to pores and microcracks. It is essential to control the selective plating process to reduce the defect content and ensure uniform properties of the nanoparticle composite coatings.
Closed Loop Controlled BaxSr1–xTio3 Thin Films In Spray Flames
Authors: Vukasinovic B. , Sundell S. , Oljaca M.
Published: September 2003

Control logic was developed for automated thin film deposition in the combustion chemical vapour deposition (CCVD) process. In situ film thickness and deposition temperature measurements were used as a feedback to control film thickness and optical properties through real-time adjustment of the deposition parameters. The closed loop controller was optimised for the deposition of barium–strontium–titanate (BaxSr1–xTiO3, BST) films on sapphire but it can be used for other coating/substrate combinations. Besides enabling repeatable depositions of BST films with optimal thickness and optical properties for electronic applications, this control process proved that unique features of the Nanomiser atomiser can be implemented to tune the film deposition rate. Comparison of scanning electron microscopy cross-sections of epitaxial BST films on sapphire substrate with the predicted film thickness suggests that the closed loop controller can be used to control the thickness of the deposited film to within ± 2%
Aluminium Enriched Diffusion Layers on Nial Alloy
Authors: Bartuška P. , Lasšek J. , Paidar V.
Published: September 2003

Materials based on Ni–Al intermetallics are prospective materials for high temperature applications. They often show good resistance to oxidation and lower specific gravity than nickel based superalloys. High temperature resistance of Ni–Al intermetallics to oxidation can often be improved by aluminium enriched surface layers. Microstructure and chemical composition of aluminium enriched layers on an Al–79 wt-%Ni alloy were investigated using SEM and local elemental analyses. The layers were prepared by diffusion annealing of the Ni–Al alloy in contact with an aluminium plate preferentially at temperatures 480–500°C, for 5 h. In these conditions continuous layers of the Ni2Al3 and NiAl3 phases originate. The region of the aluminium plate in contact with the nickel rich phases transforms into a two phase structure consisting of an aluminium matrix containing < 1 wt-%Ni and two morphological types of NiAl3 precipitates which have nominal compositions. Solid state diffusion and reactions in the Ni–Al system are also important phenomena in microelectronic devices.
Runner-up Corrosion Wear Behaviour of Low Temperature Plasma Alloyed 316 Austenitic Stainless Steel
Authors: Thaiwatthana S. , Li X. Y. , Dong H. , Bell T.
Published: September 2003

Low temperature plasma surface alloying with nitrogen (nitriding) and carbon (carburising) has been conducted to enhance the wear and corrosion resistance of AISI 316 austenitic stainless steel. In addition to detailed general characterisation of the microstructure and carbon and nitrogen depth profiles, a series of wear corrosion tests were carried out, employing a recently developed electrochemical scratching technique, to study the simultaneous effects of corrosion and wear. Results show that both plasma nitriding and carburising can improve the corrosion wear resistance of AISI 316 austenitic stainless steel but that the nitrided layer out performs the carburised layer.
Shortlisted Investigating Feasibility of Combined Hip and Solution Heat Treat Process for Production of Critical Aluminium Castings
Authors: Diem M. M.
Published: September 2003

Aluminium castings used in cyclically stressed applications need to be produced more economically. The present investigation examines the potential of a combined densification and heat treatment process. Using existing hot isostatic pressing hardware, a combined production process was developed using the Bodycote Densal process and a solution heat treatment. Three different castings were treated: permanent mould Al–Si–Mg alloy ABS master cylinder housing, sandcast Sr modified A356 experimental wedge coupon and sandcast Sr modified A356 steering knuckles. The tensile properties and fatigue behaviour of the castings was investigated using SEM and EDAX analysis. The results for the castings processed with the combined treatment were similar to the castings subjected to the more traditional production process of densification followed by heat treatment. On an industrial scale, energy savings are estimated to be ∼50% with timesavings of ∼30%.
Use of H Mode in Low Frequency Flat Spiralled Coil RF Inductively Coupled Plasma Source to Nitride Austenitic Steel Type AIsI 304
Authors: Chakrabarty C. K.
Published: September 2003

The capabilities of a low frequency flat spiralled coil rf ICP source to nitride austenitic stainless steel type AISI 304 at high rates and to extremely high surface hardness are investigated. For the purpose of testing the applicability of the plasma source in industry, large surface areas were nitrided and the uniformity of the case hardened layers was examined. Results indicate that the H mode rf ICP device improves on previous methods for the nitriding of stainless steel.
Sol Gel Alumina Coating on Fe–Cr–Al–Y Fibre Media for Catalytic Converters
Authors: Fei W. , Kuiry S. C. , Sohn Y. , Seal S.
Published: September 2003

Sol gel coating of γ-alumina was applied to Fe–Cr–Al–Y fine fibre media to examine the feasibility of using alloy fibres as a substrate for automobile catalytic converters. Two sol gel routes: aqueous based colloidal and alcohol based polymeric sol were used for coating. Prior to deposition, the fibre was oxidised in air to allow a dense α-alumina layer to form. The effect of several coating parameters such as withdrawal speed, sol concentration, soaking time and firing scheme on the coating quality and on the thickness were studied. The morphology of the coating was investigated with scanning electron microscopy (SEM) and the thickness of the coating was measured by the focused ion beam (FIB) technique. The crystal structures of the coating and the thermally grown oxide were studied with photo stimulated luminescence spectroscopy (PSLS). The coated fibre media exhibited different behaviour compared to the ordinary flat substrate. The performance of the alcohol based sol was better than that of the aqueous based sol with regard to the quality of the coating. PSLS was effective in differentiating the γ- and α-alumina.
The scimitar syndrome: clinical spectrum and surgical treatment
Authors: Schramel FM , Westermann CJ , Knaepen PJ , van den Bosch JM
Published: September 2003

We present seven patients with the scimitar syndrome. The clinical and anatomical spectrum is described. Two different types of scimitar vein was recognized. a) simple classical vein running from the middle of the right lung to the cardiophrenic angle (5 patients) and b) double arched vein in the upper and lower lung zone, with ample drainage into the left atrium and inferior caval vein (2 patients). Four patients required surgical treatment. Indications, diagnostic procedures and surgical management are discussed. In two patients, thrombosis and fibrosis occurred in the scimitar vein that had been reimplanted in the left atrium, necessitating pneumonectomy.
Respiratory mechanics and gas exchange in postobstructive pulmonary vasculopathy
Authors: Kelly SM , Bates JH , Michel RP
Published: September 2003

Chronic unilateral pulmonary artery ligation induces formation of new bronchial collateral vessels in the affected lung. These vessels form precapillary anastomoses with the pulmonary circulation and the lung is perfused with arterial blood. Inspired gas is diverted to the contralateral lung to maintain the ventilation/perfusion ratio (VA/Q) and gas exchange. This study was designed to determine the mechanism responsible for this shift of ventilation, which has not previously been investigated. We studied six dogs, before and 6 months after ligation of the left main pulmonary artery. We measured pulmonary resistance (RL) and elastance (EL), minute ventilation (VE), O2 consumption (VO2) and CO2 production (VCO2) of the right and left lungs. We also examined the effect of CO2, atropine and isoproterenol on RL and EL. In the lung with ligated pulmonary artery: 1) VE was significantly reduced; 2) RL and EL were increased and were unresponsive to CO2, atropine and isoproterenol; and 3) VO2 decreased more than VCO2 and, consequently, respiratory quotient (RQ) was greater than 1. We conclude that, with chronic pulmonary artery obstruction, ventilation shifts to the contralateral lung because of an increase in RL and EL not related to airway smooth muscle tone.
Long-term effects of prenatal indomethacin administration on the pulmonary circulation in rats
Authors: Herget J , Hampl V , Povysilova V , Slavik Z
Published: September 2003

Mechanical properties of the adult pulmonary vasculature are affected by perinatal experience of hypoxic pulmonary hypertension. In the present study, we followed the long-term effects of perinatal pulmonary hypertension induced by means other than hypoxia in rats. Daily injections of indomethacin (1 mg.kg-1 body weight (BW)) were given to the parturient rats. Their newborn pups had significantly increased number of muscularized peripheral pulmonary vessels. Pulmonary hypertension, however, did not persist to adulthood (mean pulmonary arterial pressure (Ppa) was 17.2 +/- 1.3 torr in the experimental group and 16.4 +/- 0.8 torr in controls). Pulmonary hypertension induced in adult rats by exposure to chronic hypoxia or by acute hypoxic challenges was similar in indomethacin-treated and control rats. Normoxic perfusion pressure/flow (P/Q) plots in isolated lungs were less steep in indomethacin-treated than in control rats. Acute hypoxia increased the slope of P/Q plots in indomethacin treated rats but not in controls. The described changes in the pulmonary vasculature induced by indomethacin are similar to those found previously in adult rats born in hypoxia. We conclude that perinatal pulmonary hypertension permanently modifies the pulmonary vasculature.
Atrial natriuretic peptide in acute hypoxia-exposed healthy subjects and in hypoxaemic patients
Authors: Lordick F , Hauck RW , Senekowitsch R , Emslander HP
Published: September 2003

Plasma atrial natriuretic peptide (ANP) is an endogenous vasodilator, which might counteract pulmonary hypertension due to hypoxaemia. The aim of this study was to investigate the influence of acute and chronic hypoxia on plasma (ANP) concentrations in humans. Venous plasma ANP concentrations in six healthy subjects were measured before and after inhalation of hypoxic air (11% O2) at rest for 30 min, and following 5 min of mild hypoxic exercise (25 W). Pulmonary arterial plasma ANP levels were determined in 31 right heart catheterized patients with lung disease. In healthy subjects, mean arterial oxygen tension (Pao2) was 6.8 +/- 1.9 kPa after 30 min hypoxia at rest, and 4.7 +/- 0.9 kPa after hypoxic exercise testing. Hypoxia at rest did not induce significant changes in ANP concentrations, whereas hypoxic exercise led to significantly increased ANP levels. Among hypoxaemic patients, significantly elevated plasma ANP levels were found only in the subgroup with increased mean pulmonary artery pressure, but not in the subgroup with normal pulmonary artery pressure. In summary, severe acute hypoxia induced by hypoxic exercise, but not moderate acute hypoxia at rest, leads to increased ANP levels in healthy subjects. Chronic hypoxia alone does not lead to elevated plasma ANP levels; whereas, hypoxia combined with pulmonary hypertension causes increased plasma ANP concentrations in diseased subjects.
Reduction in sympathetic activity after long-term CPAP treatment in sleep apnoea: cardiovascular implications
Authors: Hedner J , Darpo B , Ejnell H , Carlson J , Caidahl K
Published: September 2003

Twelve patients with severe obstructive sleep apnoea were included in an open, long-term, prospective, follow-up study addressing the effects of nasal continuous positive airway pressure (CPAP) on sympathetic activity, cardiac structure and blood pressure. Plasma norepinephrine (P-NE) (daytime at rest), daytime and night-time urinary excretion of NE (U-NE), vanylmandelic acid and metanephrines, together with 24 h noninvasive blood pressure (BP) recording and Doppler-echocardiography, were assessed before and after a mean of 20.5 (range 14-26) months of CPAP. Average self-reported use of CPAP was 89% (range 65-100%) of time spent in bed. Resting daytime P-NE ranged 0.35-0.83 ng.ml-1, which is elevated compared to healthy controls. Only night-time U-NE, mean daytime BP and average 24 h BP were related to severity of OSA. Night-time metanephrine was related to daytime and night-time diastolic, as well as night-time systolic, BP. Left ventricular mass index (LVMI) at baseline was correlated to daytime systolic BP and P-NE. Long-term CPAP treatment reduced biochemical markers of sympathetic activity. P-NE decreased by approximately 50%, and daytime and night-time vanylmandelic acid and metanephrine by 32-54%. In contrast, there were no overall reductions in BP or LVMI. It is concluded that obstructive sleep apnoea is associated with high sympathetic activity both during sleep and waking periods. Urinary metanephrine excretion seemed to reflect blood pressure, but neither daytime nor night-time catecholamine excretion was directly related to disease severity in patients with severe obstructive sleep apnoea.(ABSTRACT TRUNCATED AT 250 WORDS)
The effects of the GABA agonist, baclofen, on sleep and breathing
Authors: Finnimore AJ , Roebuck M , Sajkov D , McEvoy RD
Published: September 2003

The gamma aminobutyric acid (GABA)-B agonist, baclofen, is a centrally-acting, anti-spasmodic agent and muscle relaxant used in spinal cord lesions, multiple sclerosis and other neurological disorders. In a previous pilot study of quadriplegic patients, 75% of whom were treated with baclofen, we found a high prevalence of sleep-disordered breathing. Because of the depressant effects of GABA on the central nervous system, we hypothesized that baclofen might aggravate sleep-disordered breathing in susceptible individuals by depressing central ventilatory drive, increasing upper airway obstruction and/or increasing the arousal threshold to apnoea. We therefore conducted a double-blind, placebo-controlled, cross-over study of baclofen 25 mg, administered before sleep in 10 snorers with mild sleep-disordered breathing (respiratory disturbance index < 30 events per sleep hour). Each subject underwent two standard polysomnographic assessments, one week apart. Total sleep time was significantly prolonged by baclofen (placebo 356 +/- 9.9 SEM min; baclofen 386 +/- 9.9 min). Both nonrapid eye movement(REM) and REM sleep duration were increased (nonREM: placebo 295 +/- 6.8 min; baclofen 311 +/- 8.9 min; REM: placebo 61 +/- 7.5 min; baclofen 76 +/- 9.0 min). Time spent awake after sleep onset was reduced after baclofen (placebo 71 +/- 10.3 min; baclofen 51 +/- 9.7 min). There was a slight reduction in mean overnight oxygen saturation (placebo 95.2 +/- 0.5%; baclofen 94.4 +/- 0.7%). The frequency of apnoeas plus hypopnoeas (respiratory disturbance index (RDI)) did not change significantly (placebo 9 +/- 1.8 events.h-1; baclofen 13 +/- 3.4 events.h-1).(ABSTRACT TRUNCATED AT 250 WORDS)
Baclofen therapy for chronic hiccup
Authors: Guelaud C , Similowski T , Bizec JL , Cabane J , Whitelaw WA , Derenne JP
Published: September 2003

Chronic hiccup is a rare but potentially severe condition, that can be symptomatic of a variety of diseases, or idiopathic. Many therapeutic interventions have been reported, most often as case reports. Among other drugs, baclofen has been suggested as a therapy for chronic hiccup. In a large series of patients, we have evaluated its therapeutic position. In patients with chronic hiccup, defined as hiccup spell or recurring hiccup attacks lasting more than 7 days, investigation of the upper gastro-oesophageal tract (fibroscopy, manometry, and pH monitoring) was systematically performed. Most patients had tried numerous drugs in the past, without success. Baclofen was used as a first treatment in patients without evidence of any gastro-oesophageal disease (n = 17), and was undertaken only after full treatment of such disease (n = 55) had failed to solve the hiccup problem (n = 20). Baclofen has, therefore, been administered to 37 patients with chronic hiccup (average duration 4.6 yrs). Baclofen produced a long-term complete resolution (18 cases) or a considerable decrease (10 cases) of hiccups in 28 of the 37 patients. There was no significant difference between patients with or without gastro-oesophageal disease. We conclude that so-called idiopathic chronic hiccup often results from gastro-oesophageal abnormalities. Also, if controlled studies confirm our encouraging results, baclofen can be a major element in the treatment of chronic hiccup that is idiopathic, or that cannot be helped by treatment of gastro-oesophageal diseases.
Digestion of proteoglycans in porcine pancreatic elastase-induced emphysema in rats
Authors: van de Lest CH , Versteeg EM , Veerkamp JH , van Kuppevelt TH
Published: September 2003

Pulmonary emphysema was induced in rats by a single intratracheal instillation of pancreatic elastase. The short-term effects of elastase instillation on basement membrane components were evaluated using immunohistochemical and biochemical methods. Lung alveoli showed a decrease in heparan sulphate proteoglycan content (especially of its heparan sulphate chains) 3 h to 7 days after induction. Type IV collagen, laminin and fibronectin were not affected. The glycosaminoglycan content of the lung was decreased during the first 3 days after induction, while the glycosaminoglycan concentration in urine was increased during the first 4 days by an increase of heparan sulphate and dermatan sulphate. The increase in urinary glycosaminoglycan content was positively correlated with the extent of emphysema developed after 40 days. We conclude that proteoglycans are target molecules for elastase, and may be involved in the pathogenesis of emphysema.
The effect of prolonged exposure to NO2 from birth on airways responsiveness in rabbits sensitized at birth
Authors: Douglas GJ , Price JF , Page CP
Published: September 2003

Our aim was to determine whether daily exposure to 4 ppm nitrogen dioxide (NO2) from birth until 3 months of age influenced the development of airways hyperresponsiveness and atopic sensitivity in immunized rabbits. Littermate New Zealand white (NZW) rabbits were immunized within 24 h of birth by i.p. injection of house dust mite antigen in AI(OH)3 gel, and exposed to either ambient air or 4 ppm NO2 for 2 h.day-1, 5 days.week-1. At 3 months, bronchoalveolar lavage (BAL) and serum samples were obtained. Airways responsiveness was measured as the provocative concentrations (mg.ml-1) of histamine or methacholine required to elicit a 50% increase in airway resistance (RLPC50) and a 35% decrease in dynamic compliance (CdynPC35). There were no differences in total cell or differential cell counts recovered in BAL fluid between control and NO2 exposed animals. Airways responsiveness did not differ between groups of animals (histamine RLPC50 values: air (n = 15) versus NO2 (n = 13), respectively, 9.98 +/- 1.32 versus 16.43 +/- 1.45 mg.ml-1; CdynPC35 values: 16.60 +/- 1.44 versus 14.95 +/- 1.43 mg.ml-1; methacholine RLPC50 values: air (n = 14) versus NO2 (n = 12), respectively, 2.18 +/- 1.51 versus 2.21 +/- 1.32 mg.ml-1; CdynPC35 values: 2.64 +/- 1.41 versus 2.85 +/- 1.31 mg.ml-1). There was no difference in sensitization between groups of animals exposed to air or NO2, evaluated either by cutaneous responsiveness to intradermal antigen, or serum immunoglobulin E (IgE) levels assessed by the passive cutaneous anaphylaxis (PCA) reaction.(ABSTRACT TRUNCATED AT 250 WORDS)
Changes in sensitivity to methacholine after inhalation with distilled water: the role of the bronchoconstrictive response
Authors: Kivity S , Poterman R , Schwarz Y , Soferman R , Topilsky M
Published: September 2003

The inhalation of distilled water can induce bronchoconstriction and a transient increase in sensitivity to methacholine in asthmatics. The purpose of this study was to determine the role of the induced bronchoconstriction in the increased sensitivity to methacholine which follows the challenge with distilled water. Eighteen asthmatic children (age 9-17 yrs) were challenged by inhalation of distilled water. Bronchial responsiveness, the provocative concentration of methacholine producing a 20% decrease in forced expiratory volume in one second (PC20), was determined before inhalation of distilled water, and 1.5 and 24 h thereafter. Following inhalation of distilled water, eight patients (Group I) had a greater than 15% decrease in FEV1 (mean 23%); whereas, in the remaining 10 (Group II) the decrease was less than 7% (mean 1%). PC20 to methacholine, geometric mean and 95% confidence interval (CI), decreased transiently only at 1.5 h following inhalation of distilled water. The decrease was from 0.78 mg.ml-1 (95% CI 0.11-5.54 mg.ml-1) at baseline to 0.25 mg.ml-1 (95% CI 0.03-2.14 mg.ml-1) after challenge in Group I; and from 2.67 mg.ml-1 (95% CI 0.35-20.34 mg.ml-1) at baseline to 0.72 mg.ml-1 (95% CI 0.18-14.87 mg.ml-1) after challenge in Group II. The transient increase in sensitivity to methacholine observed following inhalation of distilled water occurred independently of the bronchoconstrictive response. This finding may have important clinical implications when hypo-osmolar solutions are used for delivery of drugs.
The effect of methacholine-induced acute airway narrowing on lung sounds in normal and asthmatic subjects
Authors: Schreur HJ , Vanderschoot J , Zwinderman AH , Dijkman JH , Sterk PJ
Published: September 2003

The association between lung sound alterations and airways obstruction has long been recognized in clinical practice, but the precise pathophysiological mechanisms of this relationship have not been determined. Therefore, we examined the changes in lung sounds at well-defined levels of methacholine-induced airway narrowing in eight normal and nine asthmatic subjects with normal baseline lung function. All subjects underwent phonopneumography at baseline condition and at > or = 20% fall in forced expiratory volume in one second (FEV1), and in asthmatic subjects also at > or = 40% fall in FEV1. Lung sounds were recorded at three locations on the chest wall during standardized quiet breathing, and during maximal forced breathing. Airflow-dependent power spectra were computed using fast Fourier transform. For each spectrum, we determined the intensity and frequency content of lung sounds, together with the extent of wheezing. The results were analysed using analysis of variance (ANOVA). During acute airway narrowing, the intensity and frequency content of the recorded sounds, as well as the extent of wheezing, were higher than at baseline in both groups of subjects. At similar levels of obstruction, both the pitch and the change in sound intensity with airflow were higher in asthmatics than in normal subjects. Wheezing, being nondiscriminative between the subject groups at baseline, was more prominent in asthmatics than in normal subjects at 20% fall in FEV1. We conclude that, at given levels of acute airway narrowing, lung sounds differ between asthmatics and normal subjects. This suggests that airflow-standardized phonopneumography is a sensitive method for detecting abnormalities in airway dynamics in asthma.(ABSTRACT TRUNCATED AT 250 WORDS)
Fibrosing alveolitis in systemic sclerosis: increase in memory T-cells in lung interstitium
Authors: Wells AU , Lorimer S , Majumdar S , Harrison NK , Corrin B , Black CM , Jeffery PK , du Bois RM
Published: September 2003

Despite the large numbers of T-cells present in the lungs in fibrosing alveolitis, their pathogenetic role is poorly understood. If these cells are involved in pathogenesis, they are more likely to express the CD45RO+ memory phenotype. To test this hypothesis, open lung biopsies from patients with fibrosing alveolitis associated with systemic sclerosis (FASSc) were compared with grossly normal lung taken from the periphery of lobes resected for lung cancer. Biopsies from eight patients with FASSc were compared with tissue from seven cancer controls. Paraffin sections were stained with a polyclonal anti-CD3 antibody for T-lymphocytes, monoclonal anti-CD45 antibody for leucocyte common antigen, and monoclonal anti-CD45RO antibody for primed T-lymphocytes. Staining was assessed quantitatively by computerized image analysis: in each case, the number of immunopositive cells was related to alveolar wall area and alveolar wall length. Mean alveolar wall thickness was increased in patients with FASSc (60.7 +/- 24.0 microns) compared with cancer controls (15.7 +/- 5.3 microns). Patients with FASSc had greater numbers of CD45+, CD3+ and CD45RO+ cells.mm-1 alveolar wall length compared with the controls. CD45RO+ cells made up 77% (median) of the CD3+ cells in FASSc, and their numbers per unit alveolar wall length were positively associated with alveolar wall thickness (r = 0.61). In conclusion, in fibrosing alveolitis of systemic sclerosis, most interstitial T-lymphocytes express the phenotype of memory cells; these cells are likely to be involved in the persistent inflammatory process.
The influence of ovarian hormones on the granulomatous inflammatory process in the rat lung
Authors: Shirai M , Sato A , Chida K
Published: September 2003

This study was initiated to clarify the relationship between ovarian hormones and the granulomatous inflammatory process in the lung. To assess whether ovarian dysfunction influences the granulomatous inflammatory process, we compared immunological alterations in ovariectomized rats and in sham-operated rats. After a heat-killed, bacilli Calmette-Guerin (BCG)-elicited granulomatous reaction, the lung-body weight ratios, the number of lymphocytes and activated T-cells, and the interferon-gamma levels in the bronchoalveolar lavage fluid from the ovariectomized rats were significantly higher than those of the sham-operated rats. Moreover, exogenous ovarian steroids supplemented in vivo suppressed not only the granulomatous inflammatory process in the lungs, but also the parameters measured in the bronchoalveolar fluid. These results indicate that ovarian dysfunction may adversely affect the formation of granulomas in the lung.
Drug-resistant pulmonary tuberculosis in Berlin, Germany, 1987-1993
Authors: Schaberg T , Gloger G , Reichert B , Mauch H , Lode H
Published: September 2003

Resistance of Mycobacterium tuberculosis (M.tb) strains is an increasing problem worldwide. Since no public health data are available for urban populations in Germany, we investigated resistance in our hospitalized patients (n = 1,011) over the last 7 yrs. We therefore evaluated clinical data and results of susceptibility tests (breakpoint technique/proportion method) for isoniazid, streptomycin, rifampin, pyrazinamide, protionamide and ethambutol. Since 1987, there has been a relatively constant rate of 5.9% (3.9%-7.8%) for single-drug resistance (SDR), but an increasing rate of multidrug-resistant (MDR) strains (> or = 2 first-line drugs) from 1.7% in 1987 to 5.8% in 1993. Sixty nine percent of patients with MDR strains showed resistance to two drugs, and 31% to three or more drugs. Risk factors for SDR and MDR tuberculosis revealed previous therapy (odds ratio (OR) (95% confidence interval (95% CI)); SDR 2.2 (1.7-4.0); MDR 4.5 (2.3-8.8)); and foreign-born status (SDR 2.2 (1.3-3.6); MDR 3.5 (1.8-6.8)) to be the most important factors associated with resistance. Both primary and acquired resistance were higher in foreign-born than in German-born patients. We conclude that there was a considerable increase in multidrug-resistant tuberculosis in our hospital from 1987 to 1993. Since previously treated patients and patients born in countries with a high level of primary resistance had an increased risk of drug-resistant tuberculosis, we would advise a four drug regimen as initial therapy in those patients.
Misclassification of smoking status among women in relation to exposure to environmental tobacco smoke
Authors: Riboli E , Haley NJ , Tredaniel J , Saracci R , Preston-Martin S , Trichopoulos D
Published: September 2003

In studies of the health effects of exposure to environmental tobacco smoke (ETS), misclassification of active smokers has the potential to bias the estimates of disease risk. Biochemical validation of exposure to ETS can provide objective evidence of current smoking status in epidemiological studies. Intrinsic to this effort is the establishment of appropriate cut-off points for the measurements of tobacco biomarkers. Within a collaborative study on ETS co-ordinated by the International Agency for Research on Cancer, questionnaire data and urine samples were collected from 1,369 women at 13 centres in 10 countries. Forty seven of these women had urine cotinine levels above 50 ng.mg-1 creatinine, a level used to discriminate smokers from nonsmokers in previous studies. The distributions of the subjects across cotinine values and self-reported exposure to ETS was consistent with the association, at one extreme, of moderate cotinine levels (50-150 ng.mg-1) with very high exposure to ETS, and, at the other extreme, of very high cotinine levels indicating actual use of nicotine-containing products in women with low ETS exposure. Using the cut-off point of 150 ng.mg-1, only 1.5% of the alleged nonsmokers were reclassified as current light smokers. Potential bias due to smoker misclassification is very unlikely to be responsible for the increased health risks observed in epidemiological studies on ETS.
Diagnostic and prognostic value of the new tumour marker CYFRA 21-1 in patients with squamous cell lung cancer
Authors: Niklinski J , Furman M , Chyczewska E , Chyczewski L , Rogowski F , Laudanski J
Published: September 2003

We wanted to investigate the diagnostic and prognostic significance of serum CYFRA 21-1, especially in predicting the risk of recurrence in patients with operable squamous cell lung cancer. Serum levels of CYFRA 21-1 were measured using an immunoradiometric assay (CIS bio) in 76 patients with squamous cell lung cancer (64 operable and 12 with unresectable tumours), 22 with other non-small-cell type (12 with adenocarcinoma and 10 with large-cell type) and 45 with nonmalignant lung diseases. Elevated preoperative CYFRA 21-1 levels were identified in 63% of patients with squamous cell type (SqCC), 33% with adenocarcinoma, and 30% with large-cell carcinoma type. The diagnostic specificity of the assay was 96%. Positive CYFRA 21-1 levels were observed in 33% of stage I, 52% of stage II, 76% of stage IIIa and 83% of stage IIIb patients with SqCC type. Statistically significant differences were obtained between stages I and II and between II and IIIa, but not between stages IIIa and IIIb. Recurrence-free survival probability for patients with elevated serum CYFRA 21-1 levels before surgery was 63% (24/38) versus 92% (24/26) for patients with normal serum CYFRA 21-1 levels. However, the difference was not statistically significant when adjusted for the TNM stage (primary tumour, regional lymph node involvement, occurrence of distant metastasis). In 9 of the 10 patients with increased trend for CYFRA 21-1 during follow-up, elevated serum CYFRA 21-1 levels preceded (7) or coincided (2) with the clinical detection of tumour recurrence, providing a predictive value of an increased trend of 90%.(ABSTRACT TRUNCATED AT 250 WORDS)
Increased nitric oxide in exhaled air of normal human subjects with upper respiratory tract infections
Authors: Kharitonov SA , Yates D , Barnes PJ
Published: September 2003

Viral infection may induce the expression of nitric oxide (NO) synthase, resulting in increased NO formation that has an antiviral effect. NO may be produced by various cells of the upper and lower respiratory tract, and may be detected in the exhaled air. We have studied the levels of exhaled NO in 18 normal subjects during symptomatic upper respiratory tract infections and during recovery 3 weeks later. Exhaled NO was measured using a modified chemiluminescence analyser. At the time of symptoms of upper respiratory tract infection, the peak exhaled NO values were 315 +/- 57 ppb (mean +/- SEM) and decreased to 87 +/- 9 ppb during recovery. Recovery values of exhaled NO were similar to those reported in age-matched normal control subjects (88 +/- 3 ppb, n = 72). These findings suggest that symptomatic upper respiratory tract infections markedly increase the concentration of NO in exhaled air. This may reflect the induction of nitric oxide synthase (NOS) in upper and lower respiratory tract, and may be relevant to viral exacerbations of asthma.
Delivering optimal care to the person with asthma: what are the key components and what do we mean by patient education?
Authors: Partridge MR
Published: September 2003

The new understanding of the pathogenesis of asthma has led to an increasing perception of the disease as a chronic condition, rather than one consisting of acute exacerbations. Health professionals need to help patients to accept this new understanding, and this involves a consideration of how best to deliver care and how best to enhance compliance. Good communication is essential, and structured patient education has now been shown to be cost effective. All health professionals need to think how education may best be incorporated into their care. Such care will involve the development of a partnership between health professional and the patient and their loved ones, and the acquisition by patients of skills in self-management. Several unknowns remain regarding who benefits more from group education as opposed to individual education, and some details of guided self-management. However, in the face of clear evidence of the benefits of patient education, these areas for further study should not delay the adoption of a strong commitment to education by all of those who care for those with asthma.
A simple method to detect expiratory flow limitation during spontaneous breathing
Authors: Koulouris NG , Valta P , Lavoie A , Corbeil C , Chasse M , Braidy J , Milic-Emili J
Published: September 2003

Patients with severe chronic obstructive pulmonary disease (COPD) often exhale along the same flow-volume curve during quiet breathing as during a forced expiratory vital capacity manoeuvre, and this has been taken as indicating flow limitation at rest. To obtain such curves, a body plethysmograph and the patient's co-operation are required. We propose a simple technique which does not entail these requirements. It consists in applying negative pressure at the mouth during a tidal expiration (NEP). Patients in whom NEP elicits an increase in flow throughout the expiration are not flow-limited. In contrast, patients in whom application of NEP does not elicit an increase in flow during most or part of the tidal expiration are considered as flow-limited. Using this technique, 26 stable COPD patients were studied sitting and supine. Eleven patients were flow-limited both seated and supine, eight were flow-limited only when supine, and seven were not flow-limited either seated or supine. Only 5 of 19 patients who were flow-limited seated and/or supine had severe ventilatory impairment (forced expiratory volume in one second (FEV1) < 40% predicted). We conclude that the NEP technique provides a simple, rapid, and reliable method for detection of expiratory flow limitation in spontaneously breathing subjects, which does not require the patient's co-operation, and can be applied in different body positions both at rest and during muscular exercise. Our results also indicate a high prevalence of flow limitation in COPD patients at rest, particularly when supine.
Effects of a filter at the mouth on pulmonary function tests
Authors: Fuso L , Accardo D , Bevignani G , Ferrante E , Della Corte A , Pistelli R
Published: September 2003

The aim of this study was to verify whether the increase of resistance to airflow using a filter at the mouth could determine significant systematic errors of measurement or change the diagnostic performance in a respiratory physiology laboratory. The effect of the new filter Spirobac (DAR Spa, Italy) was assessed on out-patients referred to our laboratory for routine functional evaluation. The following tests were performed: maximal expiratory flow-volume curve, plethysmographic lung volume and airway resistance, bronchodilator test, and methacholine challenge test. Each test was performed randomly, twice with the filter and twice without. Significant differences between measurements with and without filter were found for forced vital capacity, forced expiratory volume in one second, airway resistance, and specific airway conductance (sGaw). These differences were unrelated to the average values of the measurements, except for sGaw. The limits of agreement were within the range of intraindividual short-term repeatability for almost all of the function indices. The overall concordance between tests performed with and without filter was 78% for bronchodilator test and 53% for methacholine test. However, in all the cases but one, the concordance of the methacholine test was inside the short-term repeatability. We conclude that the filter Spirobac has a statistically significant effect on the results of some pulmonary function tests. However, this is not considered to be clinically significant, since the changes due to the filter were within the intraindividual variability of repeated measurements for almost all the function indices and no appreciable classification error was found in diagnostic tests.
Migratory bronchiolitis obliterans organizing pneumonia after unilateral radiation therapy for breast carcinoma
Authors: Crestani B , Kambouchner M , Soler P , Crequit J , Brauner M , Battesti JP , Valeyre D
Published: September 2003

We report the case of a 59 year old woman who developed cough, dyspnoea and fever with patchy migratory airspace infiltrates, 2 months after right breast radiation therapy for breast carcinoma. Lung infiltrates were initially localized in the irradiated area and spread to the contralateral lung. Lung biopsy, performed in an unirradiated area of the contralateral lung 9 months after completion of radiotherapy, revealed a typical histological pattern of bronchiolitis obliterans organizing pneumonia. No cause of bronchiolitis obliterans organizing pneumonia other than radiation was found. Treatment with corticosteroids resulted in rapid clinical improvement and complete resolution of airspace opacities. This case suggests that localized lung irradiation might trigger the development of a bilateral lung disease, with a histological pattern of bronchiolitis obliterans organizing pneumonia.
Migratory organizing pneumonitis "primed" by radiation therapy
Authors: Bayle JY , Nesme P , Bejui-Thivolet F , Loire R , Guerin JC , Cordier JF
Published: September 2003

We report on two women presenting with cough and fever, 4 and 7 months, respectively, after starting breast radiation therapy following surgery for breast carcinoma. Chest roentgenogram and computed tomographic (CT) scan demonstrated alveolar opacities, initially limited to the pulmonary area next to the irradiated breast, but later migrating within both lungs. Intra-alveolar granulation tissue was found in transbronchial lung biopsies. Corticosteroid treatment resulted in dramatic clinical improvement, together with complete clearing of the pulmonary opacities on chest imaging. However, clinical and imaging relapses occurred when corticosteroids were withdrawn too rapidly; with further improvement when they were reintroduced. The reported cases clearly differ from radiation pneumonitis. They were fairly typical of cryptogenic organizing pneumonitis, also called idiopathic bronchiolitis obliterans organizing pneumonia, with the exception of the radiation therapy, partially affecting the lung, which had been performed within the previous months. Since focal radiation therapy involving the lung may induce diffuse bilateral lymphocytic alveolitis, we hypothesize that this may "prime" the lung to further injury, leading to cryptogenic organizing pneumonitis.
Idiopathic chronic eosinophilic pneumonia associated with noncaseating epithelioid granulomas
Authors: Shijubo N , Fujishima T , Morita S , Nakata H , Satoh M , Uno E , Morikawa T , Abe S
Published: September 2003

A 34 year old Japanese woman was referred to our university hospital due to pulmonary opacities and bilateral hilar lymphadenopathy on chest X-ray. She also had uveitis, erythematous skin nodules, and oral and genital ulcers. Laboratory data showed eosinophilia in the circulation and bronchoalveolar lavage fluid. Histological study revealed massive eosinophilic infiltration and noncaseating epithelioid granulomas in the lung and mediastinal lymph node, without evidence of vasculitis. Pulmonary opacities, lymphadenopathy, and blood eosinophilia promptly improved with corticosteroid therapy. In this patient, idiopathic chronic eosinophilic pneumonia overlapped with features of sarcoidosis and Behcet's disease.
Fatal pulmonary hypertension and rheumatoid vasculitis
Authors: Balagopal VP , da Costa P , Greenstone MA
Published: September 2003

A 51 year old man with mild rheumatoid arthritis developed pulmonary hypertension in the absence of interstitial lung disease. A cutaneous vasculitis subsequently responded to immunosuppressive therapy, but the lung disease was refractory to treatment. In patients with rheumatoid arthritis, dyspnoea should be investigated at an early stage, even in the absence of obvious pleural or interstitial lung disease.
Transplantation of a lobe of lung from mother to child following previous transplantation with maternal bone marrow
Authors: Svendsen UG , Aggestrup S , Heilmann C , Jacobsen N , Koch C , Larsen B , Svejgaard A , Thisted B , Petterson G
Published: September 2003

A left lower lobe of the lung was transplanted from a mother to her child, who had previously received a maternal bone marrow transplant for an immune defect. Following the bone marrow transplantation, the child had developed severe pulmonary fibrosis. Surgery and the early postoperative course have been uncomplicated. Immunosuppression with corticosteroids was administered for a short period, after which all immunosuppressive treatment was discontinued. The operation and the outcome are described both in the donor and recipient. Rehabilitation was slow, but one year later the patient is doing well.