bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Alice in Wonderland’ Syndrome and Lilliputian Hallucinations in a Patient with a Substance-Related Disorder
Authors: Takaoka Ken , Takata Tomoji
Published: April 2003

The present paper describes a patient who exhibited ‘Alice in Wonderland’ (AIW) syndrome as well as lilliputian hallucinations. The patient regularly consumed a cough syrup that contained dihydrocodein phosphate and dl-methylephedrine hydrochloride over 3 years. At the age of 46, he developed AIW syndrome. The patient ingested a large dose of triazolam and exhibited delirium. Even after the disappearance of symptoms associated with AIW syndrome and delirium, the patient continued to experience lilliputian hallucinations. We believe that these hallucinations were caused by some of the components of the cough syrup.
Minor Psychiatric Disorders as Possible Complication of Mental Retardation
Authors: Molteni M. , Moretti G.
Published: April 2003

In young adult life a large proportion of mentally retarded subjects develop psychiatric complications, both severe and mild, whose origin is undoubtedly multifactorial (biological and psychological). A series of 27 subjects (13 male, 14 female; mean age 27.6 years) with IQ ranging from 70 to 40 were studied in our Institute from 1994 to 1995 and followed up 1 and 2 years later. Paykel scale (life events), FACES III (type of family insight), MFFT and Watkin’s test (cognitive styles) were used to evaluate all cases. We found that (1) minor disorders prevailed in mild and moderate mental retardation and severe disorders in profound mental retardation; (2) minor disorders were generally determined by psychological and environmental factors although biological ones may have an important role; (3) psychological factors prevailed in young adult life when the subject had to cope with relatively harder tasks, and (4) the prognosis is generally good if proper care is given.
Qualitative Research in Diagnostic Processes
Authors: Frommer Jörg
Published: April 2003

Social sciences, in general, and psychotherapy, in particular, have been informed by two fundamentally distinct methodologies of description and explanation: firstly, causal nomology based on operationalized data, and secondly, empirical hermeneutics focused on the meaningful context of intentions, experiences and actions. The paper deals with the second of these two methodologies in the context of research on psychotherapeutic diagnosis. This paradigm is a methodology for evaluating certain aspects of quality of life which deal with the subjective and interpersonal meaning of symptoms.
Ethics in Psychiatric Diagnosis from a Psychodynamic Perspective
Authors: Schmolke Margit
Published: April 2003

The diagnostic evaluation, representing a fundamental activity in psychiatric practice and research, requires a particular ethical responsibility on the part of the clinician. The author proposes the following aspects as being important for a comprehensive and ethically sensitive diagnosis: (a) incorporation of the patient’s subjective perspectives and understanding of his/her disease, (b) consideration of the patient’s quality of life, (c) assessment of the positive aspects of health, (d) awareness of group-dynamic and psychodynamic factors in the diagnostic situation, (e) the clinician’s professional competence, value orientation and personal identity, (f) therapeutic optimism as a basic attitude. The patient’s active involvement is emphasized since he is the real expert as far as his individual, social, religious and ethical needs and values are concerned.
Psychiatric Morbidity in Disintegrative Psychosis and Infantile Autism:A Long-Term Follow-Up Study
Authors: Mouridsen Svend Erik , Rich Bente , Isager Torben
Published: April 2003

In order to study the validity of disintegrative psychosis (DP), the authors compared 13 patients given this diagnosis in childhood with a control group of 39 patients with infantile autism (IA) matched for sex, age, IQ and social class on measures of psychiatric morbidity. Almost the same proportion of the two groups had been admitted to a psychiatric hospital during a 22-year follow-up period. However, there was a slight tendency (statistically nonsignificant) for the DP group to utilize the psychiatric health care system more frequently than the IA group. They had more admissions and stayed longer in hospital than patients with IA suggesting that they had more psychiatric symptoms than the IA group. The original IA diagnoses were confirmed fairly consistently during the follow-up period, while the DP group was given more heterogenous diagnoses. No diagnosis of schizophrenia was made in either group.
Clinical Homogeneity of DSM-IV Schizophrenic Disorders
Authors: Oulis P. , Lykouras L. , Tomaras V. , Stefanis C. , Christodoulou G.N.
Published: April 2003

We investigated the lifetime fulfillment of five subcriteria of diagnostic criterion A in 94 inpatients with a definite diagnosis of DSM-IV schizophrenic disorder. Among the five diagnostic features captured by criterion A, only delusions were found to be almost universal, whereas of the remaining four, only hallucinations and negative symptoms occurred in more than half of all the cases. Overall, almost 60% of the 28 possible patterns of combination among the five subcriteria were found to be fulfilled although 60% of the cases were accounted for by only 4 patterns, which were also identified by means of a cluster analysis, as accounting for the totality of the cases. The first cluster was characterized by the fulfillment of subcriteria 1,2 and 5, the second by subcriteria 1 and 2, the third by subcriteria 1 and 5 and the fourth by subcriteria 1,2, and 3. The substantial clinical heterogeneity of the DSM-IV category of schizophrenic disorders with respect to their diagnostically characteristic features captured in criterion A is traced to the polythetic character of its five subcriteria.
Capgras Syndrome and Functional Psychosis in 2 Survivors of Torture
Authors: Wenzel Thomas , Sibitz Ingrid , Kieffer William , Strobl Rainer
Published: April 2003

Functional psychosis has only rarely been described in context with extreme stressors, most studies focusing singularly on posttraumatic stress disorder symptoms. We report for the first time the case histories of 2 patients suffering from Capgras syndrome along with schizoaffective disorder and posttraumatic stress disorder after prior experience of prolonged torture. Interaction of personal life experience and psychiatric disorder are proposed as factors resulting in persistent changes in perception and affect.
Musical Hallucinations in Schizophrenia
Authors: Baba A. , Hamada H.
Published: April 2003

There have been many reports of musical hallucinations in deafness, organic brain disease and epilepsy, but few reports of their occurrence in schizophrenia. Musical hallucinations tend to be regarded as specific manifestations of deafness and organic brain disease rather than of schizophrenia. However, since schizophrenic musical hallucinations are less distressing to schizophrenic patients than verbal hallucinations and psychiatrists have little interest in them, they may be missed. We treated schizophrenic patients who experienced musical hallucinations and traced the symptomatic changes. They exhibited semeiological changes similar to the changes in verbal hallucinations. Musical hallucinations are clearly a symptom of schizophrenia. By reporting these cases, we encourage concern about this symptom, which may be missed when psychiatrists interview patients.
Can Music Alleviate Cognitive Dysfunction in Schizophrenia?
Authors: Glicksohn Joseph , Cohen Yoav
Published: April 2003

It has recently been reported that students performed relatively better on cognitive tasks after listening to music. Conceivably, music might reduce the level of arousal in subjects who are tense, thereby improving their performance. A test case would be schizophrenic subjects, noted for poor performance on tasks demanding attention, who have been characterized as suffering from hyperarousal, which mediates these attentional deficits. We investigated whether cognitive task performance could be facilitated by music in schizophrenics and report a beneficial effect.
Objective and Subjective Extrapyramidal Side Effects in Schizophrenia: Their Relationships with Negative and Depressive Symptoms
Authors: Dollfus S. , Ribeyre J.M. , Petit M.
Published: April 2003

The aim of this study was to show that objective extrapyramidal symptoms (O-EPS) were strongly correlated to negative and depressive symptoms while subjective extrapyramidal symptoms (S-EPS) were not. Ninety-one schizophrenic patients were evaluated by the Extrapyramidal Symptoms Rating Scale (ESRS), Montgomery and Asberg Depression Rating Scale (MADRS) and Scale for the Assessment of Negative Symptoms (SANS). While significant correlations were found between O-EPS and SANS (r = 0.51; p < 0.001) and between O-EPS and MADRS (r = 0.26; p < 0.01), no significant relationship existed between S-EPS and SANS (r = 0.19) or MADRS (r = 0.19). Similar results regarding the relationships between EPS and SANS were found in stabilized and acute subgroups and in deficit and nondeficit subgroups. A stepwise multiple regression showed that 41% of the variance of the SANS scores was due to facial mask and bradykinesia, and that 17% of the variance of the MADRS scores was due to facial mask and akathisia. This study shows the interest of evaluating subjective parkinsonism symptoms over objective ones since they are less interrelated to other symptoms, in particular to negatives ones.
Segmentation of Behavior and Time Structure of Movements in Depressed Patients
Authors: Lemke Matthias R. , Koethe Nils , Schleidt Margret
Published: April 2003

Psychomotor alterations are fundamental psychopathological features of major depression and observable components of behavior. Human behavior is segmented into action units with a duration of a few seconds. Cognitive and emotional dysfunctions in depression may affect the time structure of movements. Therefore, upper limb movements (total n = 707) of depressed patients and matched healtyh controls were studied using videotaped interviews and frame-by-frame analysis with an accuracy of 40 ms. Both groups displayed a similar temporal distribution, but nonrepetitive action units were significantly shorter (median = 1.16 s) and repetitive units longer (median = 4.92 s) in depressed patients compared to controls (median = 1.93 and 3.01, respectively). Movement alterations were related to anhedonia and subjective severity of depression. Altered time structure of movements represents an observable psychopathological sign and may be relevant for pathophysiological and behavioral aspects in depression.
Fury: Heroic, Bestial and Collective
Authors: Rossi Paolo
Published: April 2003

In his furies and frenzies, man’s humanity is pushed to its outermost limits; his human potential is inordinately stretched. In poetic, heroic frenzy, man reaches the gods and divinity. Yet this poetic frenzy is not an oblivion, but a memory; his frenzy is not born from forgetting himself, but from a strengthening of his own ego. Bestial fury is the tale of the self-destructive consequences of attempting to use ferocity and fury against one’s own enemies, and the endeavors to keep these forces in check and bend them towards one’s own ends. However, the fact that man displays anger and wrath is not the sign of a descent towards the feral, animal realm, but, on the contrary, of an ascent. Man has risen up towards civilization. With this have come collective furies – the common angers of a human multitude, where the single personality is nullified. Might it be that even heroic frenzy, or perhaps above all heroic frenzy, has been liberally used in our times to unleash bestial and collective fury?
Dysphoria from a Transnosological Perspective
Authors: Musalek M. , Griengl H. , Hobl B. , Sachs G. , Zoghlami A.
Published: April 2003

The objective of our psychopathological analyses is to shed light on the position of irritable mood (dysphoria) in psychiatric diagnostics and nosology. In today’s most commonly applied classification systems, the ICD-10 and the DSM-IV, dysphoria is mentioned mostly in the context of diagnostic criteria of personality and affective disorders. Other authors have emphasized the importance of dysphoric states in organic psychoses and delusional disorders. Summarizing the various publications on the nosological position, dysphoria is a nosological nonspecific syndrome which may occur in the course of all psychiatric disorders and illnesses. According to the results of our psychopathological analyses, the pathogenesis of dysphoria has to be considered as a multidimensional circular process in which various mental, physical and social factors act as predisposing, triggering and disorder-maintaining factors. Stressors induced by particular experiences and perceptions and by impaired health may lead to a dysphoric state if adequate coping mechanisms are missing. Dysphoria itself usually leads to a deterioration in the mental and physical state of the patient, and shows a clear impact on the patient’s social network. The reactions of people close to the patient combined with the impaired mental and physical conditions of the patient cause the circle to restart. As contemporary diagnostic entities do not refer to pathogenesis, classical categorical diagnostics cannot provide the basis for effective pathogenesis-oriented therapy. A change of paradigm in diagnostics from a categorical to a dimensional approach thus becomes necessary. Following a dimensional diagnostic approach based on a dynamic model of vulnerability, a precise differential diagnosis of the complex constellation of conditions and their interactions becomes necessary in order to develop effective treatment strategies. Disorder-maintaining factors determine the treatment of the acute symptomatology, whereas predisposing and triggering factors serve as the basis for the prophylactic treatment.
Can Verbalization Remedy the Theory of Mind Deficit in Schizophrenia?
Authors: Sarfati Yves , Passerieux Christine , Hardy-Baylé Marie-Christine
Published: April 2003

Several studies provide convincing evidence of a specific deficit in the theory of mind (ToM) in some patients with schizophrenia. This ToM deficit consists of an inability to attribute relevant mental states to others, and studies suggest it has to be regarded as functional and remediable through the use of reinforced context processing. To investigate this, the present study compares the performances of 25 schizophrenics and 25 matched controls in a task exploring ToM before and after the introduction of verbal material into the task, initially conceived as nonverbal. All the controls and half of the schizophrenic subjects who did not initially perform at the best level remediated with verbalization, while 9 of the schizophrenics exhibited no remediation. These poor performers are characterized by a longer duration of illness. The cognitive plasticity and the characteristics of patients who do/do not remediate are discussed in the light of findings obtained with the Wisconsin Card Sorting Test. The clinical implication of these results is important since they suggest that some patients would benefit from cognitive rehabilitation in terms of their ability to attribute relevant mental states to others.
Comparison of Assessment of Personality Disorder by Patients and Informants
Authors: Modestin Jiri , Puhan Alexis
Published: April 2003

The present study evaluated the pathology of personality disorder in a group of 8 nonpatient volunteers and 32 psychiatric in- and outpatients, most of them suffering from substance abuse disorder. The patient self-reports were compared with the reports by 2 informants for each proband. All probands and informants completed the Structured Interview for DSM-III-R Axis II Personality Questionnaire. Patient self-reports and informant reports yielded the same number of diagnoses. The diagnostic agreement between the three sets of data was generally poor; however, the concordance was slightly better between both groups of informants than between patients and informants: Median κ were 0.13 for patients versus parents, 0.14 for patients versus brothers/sisters and 0.29 for parents versus brothers/sisters. Patient and informant evaluations represent two different assessment approaches of the personality, and a complete agreement is not to be expected.
A Case of Comorbidity between Panic Disorder and Photosensitive Epilepsy
Authors: Langs Gernot , Fabisch Karin , Fabisch Hans
Published: April 2003

Panic disorder and epilepsy usually are distinct entities which require different and specific therapeutic stategies. While anticonvulsant medication is the treatment of choice for seizure disorders, behavioral methods have proven to be effective in panic disorder. We here report a case of comorbidity between panic disorder and photosensitive epilepsy. Special attention is given to the different symptomatic presentations of the disorders, because a thorough knowledge of both disorders may save unnecessary diagnostic procedures. Therefore, the necessity of taking a careful patient’s history is underlined. Furthermore the different possible relationship between panic disorder and epilepsy are discussed.
Psychological Disorders in Survivors of Torture: Exhaustion, Impairment and Depression
Authors: Wenzel T. , Griengl H. , Stompe T. , Mirzaei S. , Kieffer W.
Published: April 2003

Post-traumatic stress disorder (PTSD) has been described as the characteristic sequel to extreme events in life such as war and especially torture. This limitation to a single approach in regard to diagnosis and treatment has been criticised as being a too narrow concept to describe the effects following extreme events in life, especially as most studies so far were limited to PTSD and a small range of symptoms or disorders. The study presents data on psychiatric disorders in a group of exiled survivors of torture presenting to an out-patient department for psychiatry. A DSM-III-R-based psychiatric interview, including the general assessment of functioning scale (GAF), an open list of symptoms and the Vienna diagnostic criteria in regard to depression were used to evaluate a broader range of possible sequels. The most frequent present diagnosis in 44 patients seen over a period of 3 years was PTSD (n = 40), but criteria for a present diagnosis of other disorders were fulfilled in 34 patients, even years after torture, mainly major depression or dysthymia (n = 26). Criteria for functional psychosis were fulfilled in 4 patients. Many patients reported symptoms not assessed by DSM-III-R criteria, including feelings of shame and guilt, and ruminations on existential fears. The impairment as indicated by the GAF (mean 59.1) correlated best with the presence of the endogenomorphic-depressive axial syndrome, but not with duration of imprisonment, age or other factors. Research on sequels to extreme trauma should not be restricted to a simple diagnosis of PTSD, but should continue to look for a broader conceptualisation, including neglected categories like the axial syndrome, as PTSD is common, but might not be the only factor of importance for research and treatment. ICD-10 might offer a more adequate interpretation of sequels.
Quality of Life in Depression and Anxiety Disorders: An Exploratory Follow-Up Study after Intensive Inpatient Cognitive Behaviour Therapy
Authors: Lenz G. , Demal U.
Published: April 2003

Thirty-seven patients with depression and anxiety disorder, who participated in an intensive inpatient cognitive behaviour therapy program for 6 weeks, were interviewed before treatment and 6 weeks after the end of treatment; in addition to other measures, quality of life was assessed with the Berlin Quality of Life Profile. Substantial reduction in subjective quality of life, objective functioning and environmental assets was found at baseline. At follow-up, according to clinical global impression, 13.5% of the patients were very much improved, 45.9% much improved; in 26.3% only slight improvement and in 16.2% no improvement was reported. Quality of life changed for the better in areas like work and education, leisure, housing, social relations, psychological well-being and a global rating of satisfaction with life, but not in marital relations, health in general and in finances.
Seasonal Variation in Suicide in a Predominantly Caucasian Tropical/Subtropical Region of Australia
Authors: Cantor C.H. , Hickey P.A. , De Leo D.
Published: April 2003

Seasonal variations in suicide were examined in a Caucasian population living relatively close to the equator. A spring/early summer peak, but no secondary autumn peak, was found for males. An autumn trough was found for females. No significant seasonal variation was found for rurality, distance from the equator, employment status, or methods of suicide. Post-mortem blood alcohol levels were higher in spring and summer, possibly reflecting socialization patterns. The modest associations are consistent with suggestion that climatic influences may produce greater variation in suicide rates where the climatic variation itself is greater.
Clinical Features of Delusional Beliefs in Schizophrenic and Unipolar Mood Disorders: A Comparative Study
Authors: Oulis P. , Lykouras L. , Gournellis R. , Mamounas J. , Hatzimanolis J. , Christodoulou G.N.
Published: April 2003

We assessed comparatively 13 clinical features of delusions in a sample of 132 deluded inpatients of both sexes with schizophrenic (n = 89) or unipolar mood disorders (n = 43). Patients with schizophrenic disorders exhibited higher levels of severity than those with unipolar depression with respect to the features of vagueness-illogicality, bizarreness, systematization, conviction, duration and affective incongruence, whereas the reverse held true with respect to the feature of emotional impact. Furthermore, the two diagnostic groups were compared to each other with respect to patients’ scores on five dimensions of their delusions obtained through factor analysis, namely emotional and behavioral impact, cognitive disintegration, delusional certainty, volitional dyscontrol and affective inappropriateness. Schizophrenic patients exhibited higher levels of severity than depressives on the second and fifth dimensions, whereas the reverse held true with respect to the fourth one. Our results suggest that particular features of delusions as well as broader dimensions thereof, may assist in the differential diagnosis of unipolar depression with psychotic features from schizophrenic disorders.
Relationship between Diagnostic Subtypes of Depression and Occupation in Japan
Authors: Otsuka K. , Kato S.
Published: April 2003

The relationship between occupational groups and the subtypes of endogenous depression was investigated. 98 patients who were diagnosed as having endogenous depression and hospitalized in the psychiatric department of a medical school hospital over the 15-year period between 1981 and 1996 were divided into two occupational groups: 67 patients were classified as belonging to the industrialized society occupation group (e.g., office workers, managers, teachers and technicians) and 31 patients were classified as belonging to the traditional society occupation group (e.g., farmers and skilled manual workers). The unipolar-to-bipolar depression ratio for the industrialized society occupation group was revealed to be higher than that of the traditional society occupation group. This finding seems to support the view that the incidence of unipolar depression has increased with the process of industrialization. However, bipolar depression is less likely to be affected by societal and cultural changes due to the probably biologically dominant etiology of this form of depression.
Sarcoidosis: Family Contact Study
Authors: Fité E. , Alsina J.M. , Antó J.M. , Morera J.
Published: April 2003

Aim: To assess the familial aggregation in sarcoidosis in our environment. Methods: The medical centers of Catalonia (Spain) were approached to identify, retrospectively, patients diagnosed as sarcoidosis from 1986 to 1988. 245 sarcoidosis cases were recorded (annual incidence: 1.36/100,000 inhabitants). Finally, in 1990 a telephone questionnaire was administered to 188 sarcoidosis cases. Results: These cases reported 3,757 familial contacts, 5 of whom had confirmed sarcoidosis. The clinical presentation of familial sarcoidosis was similar to nonfamilial sarcoidosis, only Löfgren syndrome stood out. The prevalence of sarcoidosis among familial contacts was 1.33/1,000. Conclusions: The familial association is low and corresponds with the low annual incidence in our community.
Treatment of Chronic, Refractory Cough with Baclofen
Authors: Dicpinigaitis Peter V. , Rauf Khalid
Published: April 2003

Chronic, nonproductive cough may result from enhanced sensitivity of the cough reflex. Often, this debilitating symptom is refractory to standard antitussive therapy. Baclofen, an agonist of γ-aminobutyric acid (GABA), has been shown, in animals, to have antitussive activity via a central mechanism. Recently, in normal subjects, we have demonstrated the ability of baclofen to inhibit capsaicin-induced cough, as well as cough due to angiotensin-converting enzyme (ACE) inhibitors. Herein, we describe two patients with chronic, refractory cough who obtained symptomatic improvement after a 14-day course of low-dose, oral baclofen, administered in a double-blind, placebo-controlled manner. In addition, both subjects demonstrated significant increases in cough threshold to inhaled capsaicin after treatment with baclofen.
Pediatric Tuberculosis: Clinical Presentation and Contact Investigation at anUr ban Medical Center
Authors: Watchi Ralph , Kahlstrom Emily , Vachon Linda A. , Barnes Peter F.
Published: April 2003

Objective: (A) To characterize the clinical presentation of pediatric tuberculosis in Los Angeles County; (B) to determine the efficacy of contact investigation in identifying a source case for children with tuberculosis. Methods: We reviewed the medical records, chest radiograph and Tuberculosis Control records of 34 children (age <15 years) evaluated at Los Angeles County from January 1992 through December 1993. Results: All patients were hispanic. The mean age was 2.2 years. Thirty-three patients (97%) had intrathoracic disease. Eighteen patients (53%) were symptomatic and the most common symptoms were fever and cough. The contact investigation revealed only 4 patients (2%) to be adult source cases with active tuberculosis. Conclusion: The clinical features of pediatric tuberculosis in Los Angeles County confirm results previously reported in other parts of the US. In contrast, the identification of adult source cases is suboptimal. Improved methods of contact tracing are needed when evaluating children with tuberculosis.
Atopy, Airway Reactivity and Compressed Air Diving in Males
Authors: Tetzlaff Kay , Neubauer Birger , Reuter Michael , Friege Lars
Published: April 2003

A decline in expiratory flow rates in divers has recently been attributed to chronic exposure to hyberbaric air. Airway hyperresponsiveness (AHR) to stimuli due to a hyperbaric environment may play a certain role in this context. The aim of this study was to determine the prevalence of AHR in compressed air divers and to assess the value of bronchial challenges for prediction of fitness to dive. A cross-sectional sample of 59 healthy male volunteers – 28 divers and 31 diving candidates (controls) – who had been found fit to dive in a diving medical examination underwent additional allergy screening (skin prick and serum IgE) and a histamine bronchial challenge. Pre- and postchallenge body plethysmography was completed to assess AHR. AHR to histamine was significantly increased among divers and positively related to diving experience whereas divers and controls did not differ significantly with respect to age, anthropometric data, current smoking habits, skin prick reaction, and elevated serum IgE. Our results indicate an increased prevalence of AHR to nonspecific inhalation stimuli in experienced divers. Bronchial challenge tests may be helpful to detect asthmatics in the medical assessment of fitness to dive and for follow-up examinations during a diver’s career.
Rhodococcus equi Lung Abscess Complicating Evan’s Syndrome Treated with Corticosteroid
Authors: Tsang Kenneth W.T. , Lam Peter S.P. , Yuen Kwok Y. , Ooi Clara C.G. , Lam Wah-kit , Ip Mary
Published: April 2003

We report a case of Rhodococcus equi, an unusual pathogen, causing a right upper lobe lung abscess in a patient with Evan’s syndrome (auto-immune haemolytic anaemia and thrombocytopenia) who was treated with high-dose corticosteroid therapy. The patient was treated successfully with clarithromycin, vancomycin, ciprofloxacin and imipenen which appear to be effective in combination for this unusual condition in which the treatment regimen has been controversial.
Pharmacologic Characterization of Latex Extracts by Isolated Guinea Pig Tracheal Tissue
Authors: Schachter E. Neil , Zuskin Eugenija , Rienzi Nicholas , Goswami Satindra , Maayani Saul
Published: April 2003

Latex manufacturing workers are exposed to a heterogeneous aerosol of organic compounds. Previous studies of latex workers involved in glove production indicate that these individuals are at risk of developing respiratory symptoms and impaired lung function. The effect of latex extracts on isolated guinea pig tracheal smooth muscles was studied using latex water-soluble extracts obtained at different stages of the industrial process. Latex extracts were prepared as a 1:10 (w/v) solution. Dose-related contractions of nonsensitized guinea pig trachea were demonstrated using two latex extracts (latex 1 and latex 2). Latex 1 was prepared from the native latex and latex 2 from a processed form of latex which was relatively free of soluble proteins. Pharmacologic studies were performed by pretreating guinea pig tracheal tissue with drugs known to modulate smooth muscle contraction: atropine, indomethacin, pyrilamine, nordihydroguaiacetic acid, acivicin, trimethobenzoic acid and capsaicin. Constrictor effects of the dust extracts were inhibited by a wide variety of these agents. Atropine consistently and strikingly reduced the contractile effects of these extracts. This observation may suggest an interaction of the extracts with parasympathetic nerves or more directly with muscarinic receptors. Inhibition of contraction by blocking other mediators was less effective and varied with the dust extract. Pretreatment with capsaicin did not change the constrictor effects of latex 1 but enhanced the effects of latex 2. Depletion of neuropeptides, however, did not reduce the constrictor effect. We suggest that latex extracts cause dose-related airway smooth muscle constriction by nonimmunological mechanisms involving a variety of airway mediators and possibly cholinergic receptors. This effect is not dependent on the presensitization of guinea pigs.
Comparison of Rigid and Flexible Transbronchial Needle Aspiration in the Staging of Bronchogenic Carcinoma
Authors: Bilaceroglu Semra , Cagiotariotaciota Ufuk , Günel Özden , Bayol Ümit , Perim Kunter
Published: April 2003

In staging bronchogenic carcinoma by transbronchial needle aspiration (TBNA), rigid histology needles are generally preferred to flexible cytology needles owing to the widespread opinion that rigid needles have higher diagnostic yield and less false-positive results. The objective of this study was to compare the efficacy and safety of the rigid and flexible TBNAs in staging bronchogenic carcinoma to establish whether a flexible cytology needle method can replace the rigid needle. A prospective study was conducted in 138 consecutive patients with extra- or endobronchial masses suggestive of bronchogenic carcinoma and amenable to surgical procedures. All 8 mm and larger paratracheal, carinal, hilar and/or main bronchial lymph nodes determined before bronchoscopy by computed tomography (CT) were sampled by successive 18-gauge rigid and 21-gauge flexible TBNAs in the same session. The anatomic landmarks were followed precisely during TBNAs, and a proper technique applied in sampling and specimen processing. Malignant lymph node involvement was specified in 97 (72%) cases of bronchogenic carcinoma by rigid, and in 89 (66%) by flexible TBNA. There were 4 (100%) benign cases (3 with tuberculosis and 1 with sarcoidosis) of 101 (73%) with positive rigid TBNAs (82 with histological and 19 with cytological specimens). TBNAs determined malignant lymph node involvement in a total of 104 (78%) patients. Of 30 TBNA-negative patients, 14 were proven to have false-negative TBNAs by mediastinoscopy/mediastinotomy/minithoracotomy, and 16 to have true-negative TBNAs by thoracotomy. Thoracotomy confirmed true positivity in 52 rigid and 49 flexible TBNAs, and false negativity in 4 rigid and 7 flexible TBNAs. Further staging was confirmed in these 7 cases. Four had proven false-negative results by both methods. The presence of small cell carcinoma (21) or N3 disease (27) presented a contraindication to thoracotomy in 48 TBNA-positive patients. Adequate-quality and malignant lymph node specimens were more frequently obtained by both techniques at advanced tumor and node stages. However, malignant lymph node invasion was significantly more frequent in rigid and flexible TBNA specimens only in the presence of advanced tumor status and abnormal endoscopic appearance. The sensitivities of rigid and flexible TBNAs were 74 and 70%, respectively (p > 0.05), but both had a specificity of 100%. Neither false-positive results nor serious complications other than hemorrhage of 30–100 ml (rigid: 5%, flexible: 2%) were encountered with either technique. These results indicate that in bronchogenic carcinoma, hilar and mediastinal lymph nodes can be staged by 21-gauge flexible TBNA (76%) as accurately as by 18-gauge rigid TBNA (79%) if a proper technique is applied and anatomic landmarks are followed precisely (p > 0.05).
Using 99mTc-DTPA Radioaerosol Inhalation Lung Scintigraphies to Detect the Lung Injury Induced by Consuming Sauropus androgynus Vegetable and Comparison with Conventional Pulmonary Function Tests
Authors: Kao C.H. , Ho Y.J. , Wu C.L. , ChangLai S.P.
Published: April 2003

Consuming Sauropus androgynus, a Malaysian plant, to reduce body weight began to become fashionable in Taiwan in 1994. According to some reports, people consuming this vegetable developed lung injuries. From July to November 1995, there were 81 nonsmoking women admitted to our hospital. Thirty-six cases had respiratory symptoms/signs and the remaining 45 had no symptoms/signs. We investigated these patients with pulmonary function tests (PFT) and technetium-99m DTPA radioaerosol inhalation lung scintigraphies (DTPA lung scan), a test to evaluate the lung ventilation and alveolar epithelial permeability. Eighteen patients had abnormal results in PFT, including obstructive type (n = 17), restrictive type (n = 5), and both (n = 4). There were 33 patients with abnormalities in DTPA lung scans, including unhomogeneous deposition of DTPA radioaerosols (n = 19), faster clearance of radioaerosols from lung (n = 26), and both (n = 12). Analyzing the results, we found that the patients with respiratory symptoms had a higher incidence of abnormal results of PFT and DTPA lung scans than the patients without respiratory symptoms (p < 0.05). Besides, we found that the DTPA lung scan was more sensitive than chest x-ray and PFT in detecting the lung injuries related to the consumption of S. androgynus (p < 0.05). Consuming S. androgynus can result in symptomatic or asymptomatic lung injuries, manifested as obstructive or restrictive ventilatory impairment, unhomogeneous radioaerosol distribution, and increased alveolar epithelial permeability. In addition, measurement of the 99mTc-DTPA clearance is the most sensitive test to detect the lung injuries caused by consuming S. androgynus.
Comparison of the Bronchodilator Effects of Salbutamol Delivered via a Metered-Dose Inhaler with Spacer, a Dry-Powder Inhaler, and a Jet Nebulizer in Patients with Chronic Obstructive Pulmonary Disease
Authors: Ikeda Akihiko , Nishimura Koichi , Koyama Hiroshi , Tsukino Mitsuhiro , Hajiro Takashi , Mishima Michiaki , Izumi Takateru
Published: April 2003

The aim of this study was to compare the bronchodilator effects of salbutamol delivered via three different devices: a dry-powder inhaler (DPI), a metered-dose inhaler (MDI) with a large-volume spacer and a jet nebulizer (NEB) in patients with stable chronic obstructive pulmonary disease (COPD). Ten male patients with stable COPD [age: 67.2 ± 3.8 years, forced expiratory volume in 1 s (FEV1): 1.56 ± 0.32 liters] were studied in a randomized, double-blind and crossover manner. Each patient received 200 or 1,000 µg salbutamol via an MDI with an InspirEaseTM spacer, a RotahalerTM, or a DeVilbiss 646TM nebulizer (NEB), or matching placebo on 7 separate days. Spirometry was performed before and 15, 30, 60, 90, 120, and 240 min after inhalation. With the 200-µg dose, only DPI produced a small but greater response in maximum FEV1 and in area under the time-response curve (AUC-FEV1) compared with placebo. With the 1,000-µg dose, DPI and MDI produced equally greater improvements in both maximum FEV1 and AUC–FEV1 than NEB. An equal bronchodilating effect can be obtained using either DPI or MDI with a spacer device, whereas the NEB was less effective when the same dose was administered.
A Chest Wall Restrictor to Study Effects on Pulmonary Function and Exercise
Authors: Gonzalez Juan , Coast J.Richard , Lawler JohnM. , Welch HughG.
Published: April 2003

Chest wall restriction, whether caused by disease or mechanical constraints such as protective outerwear, can cause decrements in pulmonary function and exercise capacity. However, the study of the oxygen cost associated with mechanical chest restriction has so far been purely qualitative. The previous paper in this series described a device to impose external chest wall restriction, its effects on forced spirometric volumes, and its test-retest reliability. The purpose of this experiment was to measure the oxygen cost associated with varied levels of external chest wall restriction. Oxygen uptake and electromyogram (EMG) of the external intercostals were recorded during chest restriction in 10 healthy males. Subjects rested for 9 min before undergoing volitional isocapnic hyperpnea for 6 min. Subjects breathed at minute ventilations (V·I) of 30, 60, and 90 liters/min with chest wall loads of 0, 25, 50 and 75 mm Hg applied. Frequency of breathing was set at 15, 30, and 45 breaths per minute with a constant tidal volume (VT) of 2 liters. Oxygen uptake was measured continuously at rest and throughout the hyperventilation bouts, while controlling V·I and VT. Integrated EMG (IEMG) from the 3rd intercostal space was recorded during each minute of rest and hyperventilation. Two-way ANOVA with repeated measures revealed that chest wall loading and hyperpnea significantly increased V·O2 values (p < 0.01). External intercostal IEMG levels were significantly increased (p < 0.05) at higher restrictive load (50 and 75 mm Hg) and at the highest minute ventilation (90 liters/min). These data suggest that there is a significant and quantifiable increase in the oxygen cost associated with external chest wall restriction which is directly related to the level of chest wall restriction.
Transient Pulmonary Infiltrates during Treatment with Anti-Thymocyte Globulin
Authors: Maillard Natacha , Foucher Pascal , Caillot Denis , Durand Christine , Sgro Catherine , Camus Philippe
Published: April 2003

We report the case of a 54-year-old woman with aplastic anemia, who developed transient pulmonary infiltrates following intravenous infusion of rabbit antithymocyte globulin (ATG) for 3 days. There was no other explanation than the infusion of ATG for the infiltrates. Rechallenge with ATG induced the recurrence of opacities on the chest radiograph. Although rarely involved with only 4 previous reports, ATG should be included in the list of drugs capable of inducing pulmonary infiltrates.
Repetitive Hemodilution in Chronic Obstructive Pulmonary Disease and Pulmonary Hypertension: Effects on Pulmonary Hemodynamics, Gas Exchange, and Exercise Capacity
Authors: Borst Mathias M. , Leschke Matthias , König Ursula , Worth Heinrich
Published: April 2003

Background: In cor pulmonale associated with severe chronic obstructive pulmonary disease (COPD), disturbances of pulmonary microcirculation may contribute significantly to hypoxemia, pulmonary hypertension, and exercise intolerance. Objective: It was tested whether reduction of blood viscosity induced by repetitive hemodilution might improve pulmonary hemodynamics and oxygen uptake. Methods: Seven patients with stable COPD (forced expiratory volume in 1 s 33 ± 3 % of predicted, means ± SE) and pulmonary hypertension were phlebotomized 5–6 times over a period of 3 months with substitution of 6% hydroxyethyl starch (molecular weight 40,000). This resulted in a stepwise reduction of the hematocrit from 53.3 ± 2.6 to 45.8 ± 3.1% and a reduction of whole blood viscosity from 9.8 ± 0.6 to 8.8 ± 0.7 mPa × s at a shear rate of 2.0 s–1. Before and after the treatment period, patients underwent cardiopulmonary exercise testing and right heart catheterization. Results: Mean pulmonary artery pressure (PAm) decreased from 30 ± 3 to 22 ± 2 mm Hg and arterial oxygen partial pressure (PaO2) increased from 63.2 ± 2.2 to 71.8 ± 3.7 mm Hg at rest. During peak exercise, PAm decreased from 59 ± 7 to 53 ± 7 mm Hg and PaO2 increased from 54.0 ± 5.7 to 63.2 ± 2.4 mm Hg after hemodilution. Peak oxygen consumption rose from 573 ± 84 to 750 ± 59 ml × min–1, corresponding to an increase in cardiac index from 4.25 ± 0.5 to 5.88 ± 0.76 liters × min–1 × m–2. Pulmonary vascular resistance fell from 345 ± 53 to 194 ± 32 dyn × s × cm–5. The patients’ peak exercise capacity increased from 9.2 ± 2.0 before to 13.5 ± 3.2 kJ at the end of the study (p < 0.05 for all differences, paired t test). Conclusion: The findings suggest that a prolonged improvement of pulmonary microcirculation by reducing blood viscosity may improve pulmonary gas exchange, central hemodynamics, and exercise tolerance in patients with severe COPD and pulmonary hypertension.
Effect of Pulmonary Edema on Tracheal Diameter
Authors: Snapper James R. , Trochtenberg D. Scott , Hwang Young S. , Lefferts Peter L. , Carroll Frank E. , Worrell John A. , O’Donnell Dennis M.
Published: April 2003

Background: Though it is well known that cardiogenic and noncardiogenic pulmonary edema can cause changes in lung mechanics, actual alterations in tracheal diameter have not been described. Objective: To evaluate the effects of pulmonary edema induced by increased left atrial pressure (cardiogenic) and Perilla ketone (PK; noncardiogenic) on tracheal diameter in chronically instrumented awake sheep. Methods: We investigated the effects of two mechanistically distinct types of pulmonary edema on tracheal diameter in chronically instrumented awake sheep. Cardiogenic pulmonary edema (analogous to congestive heart failure in humans) was induced by increasing left atrial pressure (↑PLA) by inflating the balloon on a Foley catheter positioned in the mitral valve annulus to cause partial obstruction to flow across the valve (n = 18). Noncardiogenic pulmonary edema (increased pulmonary microvascular permeability pulmonary edema analogous to the acute respiratory distress syndrome in humans) was produced by the intravenous administration of PK (n = 11). Lateral chest radiographs (CXRs) were scored by a standardized 5-point scoring system for the severity of pulmonary edema, and tracheal diameter was measured at a fixed location in the carina. Three radiologists, blinded to sheep identification number and experimental protocol, evaluated the radiographs independently at different points in time for edema severity and tracheal diameter. The sheep were sacrificed immediately after the final CXR, and wet/dry lung weight ratio (W/D ratio) was determined. Results: Both ↑PLA and PK were associated with statistically significant tracheal narrowing (↑PLA: 20.3 ± 0.6 to 15.1 ± 0.9 mm; PK: 20.2 ± 0.6 to 14.1 ± 1.4 mm). Tracheal narrowing correlated with the severity of the pulmonary edema determined radiographically (↑PLA: r = –0.69, p < 0.01; PK: r = –0.62, p < 0.01) and by W/D ratio (↑PLA: r = –0.64, p < 0.05; PK: r = –0.54, p < 0.05). Conclusions: We conclude that tracheal narrowing occurs in sheep models of both cardiogenic and noncardiogenic pulmonary edema and that the degree of narrowing correlates with the severity of the edema.
Successful Use of Gonadotropin-Releasing Hormone Agonist in a Patient with Pulmonary Endometriosis
Authors: Koizumi Tomonobu , Inagaki Hiroshi , Takabayashi Yasuki , Kubo Keishi
Published: April 2003

A 26-year-old single female was admitted to hospital with recurrent chest pain, cough and hemoptysis. The symptoms developed 5 months before admission coinciding with menstruation. The disease was diagnosed as pulmonary endometriosis. She was treated with a long-acting gonadotropin-releasing hormone analogue (GnRH agonist; sustained-release leuprolide acetate, 3.75 mg/month, i.m.) for 6 months. She remained asymptomatic for 16 months with regular menstruation even after discontinuing the treatment. This indicates that the initial treatment of pulmonary endometriosis with a GnRH agonist is an acceptable medical alternative, especially in patients with a short duration of the disease from the onset of the chest symptoms.
N-Acetylcysteine Reduces the Exacerbation Rate in Patients with Moderate to Severe COPD
Authors: Pela R. , Calcagni A.M. , Subiaco S. , Isidori P. , Tubaldi A. , Sanguinetti C.M.
Published: April 2003

Objective: This study was performed to confirm the efficacy of a 6-month therapy with a formulation of N-acetylcysteine (NAC; 600 mg/day p.o.) on frequency and severity of exacerbations in patients suffering from chronic obstructive pulmonary disease (COPD). Methods: One hundred sixty-nine patients attending five Italian centres were recruited in an open, randomized, controlled study. The patients were randomly allocated to standard therapy plus NAC 600 mg once a day or standard therapy alone over a 6-month period. At baseline, medical history was evaluated, and physical examination was performed; occurrence and severity of exacerbations and side effects of NAC were analyzed after 3 and 6 months. Results: The results showed a decreased number of exacerbations (by 41%) in the group of patients treated with NAC and standard treatment: 46 patients had at least one exacerbation as compared with 63 patients of the group treated with standard therapy alone. Also the number of the patients with two or more exacerbations was lower in the NAC group (26%) than in the standard-therapy group (49%). The number of sick days was less (82) in the NAC group as compared with the standard-therapy group (155). There was a small but significant improvement in FEV1 and MEF50 in the NAC group. NAC once a day was well tolerated. There were no differences in the number of side effects reported in both groups. Conclusions: These data confirm results of previous studies which reported a reduction in the number of exacerbations in patients having moderate to severe COPD treated with the antioxidant NAC. Further, the once-daily formulation is well tolerated and is likely to improve patient compliance with the prescribed regimen.