bluuebunny/crossref_metadata_2025_split huggingface dataset:
Imaging guided thoracic interventions
Authors: Ghaye B. , Dondelinger R.F. 
Published: July 2002

Interventional Radiology is a technique based medical specialty, using all available imaging modalities (fluoroscopy, ultrasound, computed tomography, magnetic resonance, angiography) for guidance of interventional techniques for diagnostic or therapeutic purposes.Actual, percutaneous transthoracic needle biopsy includes core needle biopsy besides fine needle aspiration. Any pleural, pulmonary or mediastinal fluid or gas collection is amenable to percutaneous pulmonary catheter drainage.Treatment of haemoptysis of the bronchial artery or pulmonary artery origin, transcatheter embolization of pulmonary arteriovenous malformations and pseudoaneurysms, angioplasty and stenting of the superior vena caval system and percutaneous foreign body retrieval are well established routine procedures, precluding unnecessary surgery. These techniques are safe and effective in experienced hands.Computed tomography is helpful in pre- and postoperative imaging of patients being considered for endobronchial stenting. Many procedures can be performed on an outpatient basis, thus increasing the cost-effectiveness of radiologically guided interventions in the thorax.
M. tuberculosis: immunology and vaccination
Authors: Rook G.A.W. , Seah G. , Ustianowski A. 
Published: July 2002

Tuberculosis is increasing. Current treatment regimens require at least 6 months, because latent or stationary phase organisms are difficult to kill. Such regimens do not achieve full compliance, and “directly observed therapy short course” (DOTS) is having less impact than expected. This worrying situation is aggravated by coinfection with human immunodeficiency virus (HIV), and by the increase in drug-resistant strains.We need new insights that lead to more rapid therapies and immunotherapies, and more reliable vaccines.Recent insights have come from: understanding of the relationship betweenMycobacterium tuberculosisand macrophages; the multiple T cell types that recognise mycobacterial peptides, lipids and glycolipids; the critical role of interferon‐γ (IFNγ) and interleukin‐12 (IL‐12) in human mycobacterial infection revealed by genetically defective children; quantitation of the presence and importance of Th2 lymphocyte activation in human tuberculosis; the role of local conversion of inactive cortisone to active cortisol in the lesions; the recognition that some effective prophylactic vaccines also work as immumotherapeutics whereas others do not. In the longer term the recent sequencing of theM. tuberculosisgenome will lead to further advances.In the short term, effective immunotherapy remains the most accessible breakthrough in the management of tuberculosis. The types of practical advance that will result from sequencing the genome are discussed speculatively, but cannot yet be predicted with certainty.
Magnetic resonance analysis of abnormal diaphragmatic motion in patients with emphysema
Authors: Iwasawa T. , Kagei S. , Gotoh T. , Yoshiike Y. , Matsushita K. , Kurihara H. , Saito K. , Matsubara S. 
Published: July 2002

The purpose of this study was to quantitatively evaluate paradoxical diaphragmatic motion using magnetic resonance (MR) imaging.A total of 27 subjects were examined, including 12 normal young adults, six control individuals, and nine patients with emphysema. With subjects in the supine position, 30 sequential sagittal MR images of the entire right lung were obtained during tidal and deep slow breathing.Diaphragmatic movement between sequential images was estimated as the displacement area and the total diaphragmatic movement in a respiratory cycle was calculated. The paradoxical motion of the diaphragm, representing the inverted movement to increase or decrease lung area, since paradoxical movement ratio (Mpr=(total paradoxical diaphragmatic movement/total diaphragmatic movement)×100), was evaluated.In patients with emphysema, paradoxical diaphragmatic motion was observed on MR images during deep breathing. The mean Mprin emphysematous patients during deep breathing was 10±4%, which was significantly higher than 0.5±0.2% in young adults (p<0.05), and 1.2±0.6% in aged-matched controls (p<0.05).The present results indicate that magnetic resonance images could be used to detect paradoxical diaphragmatic motion in patients with emphysema.
Associations between markers of respiratory morbidity in European children
Authors: Timonen K.L. , Schwartz J. , Nielsen J. , Brunekreef B. 
Published: July 2002

School-aged children often experience acute respiratory symptoms. In a multicentre European study, the association between chronic respiratory symptoms (reported in a questionnaire), skin-prick test results, and lung function, and the occurrence of acute respiratory morbidity, was examined among children aged 6–12 yrs with chronic respiratory symptoms.Children with chronic respiratory symptoms, living in 10 European countries, were selected from a parent-completed questionnaire (n=4,307). Atopy was measured with skin-prick tests, and lung function with spirometry. A total of 1,854 (86% of those in the initial cohort) children kept a successful daily diary regarding their respiratory symptoms for 2–3 months.In multivariate logistic regression analyses, children with asthmatic symptoms, particularly those with doctor-diagnosed asthma, had a greater risk of occurrence of lower respiratory symptoms (odds ratio (OR): 6.12; 95% confidence interval (CI): 4.99–8.35) than children with a dry nocturnal cough as their only symptom. Atopy, particularly a positive reaction to indoor allergens, was significantly associated with occurrence of lower respiratory symptoms. For atopy the OR was 1.62 (95% CI: 1.34–1.96). A reduced level of maximal mid-expiratory flow was associated with an increased risk of lower respiratory symptoms, cough and phlegm. The associations were similar in Scandinavia, Central Eastern, Western and Southern Europe.To conclude, asthmatic symptoms reported in a questionnaire, atopic status and a reduced level of maximal mid-expiratory flow were associated with the occurrence of acute respiratory symptoms, especially those of lower respiratory symptoms.
Aerosolized iloprost induces a mild but sustained inhibition of platelet aggregation
Authors: Beghetti M. , Reber G. , de Moerloose P. , Vadas L. , Chiappe A. , Spahr-Schopfer I. , Rimensberger P.C. 
Published: July 2002

Pathological studies have revealed that one of the main features encountered in the pulmonary vasculature of patients with pulmonary hypertension is the presence of thrombotic lesions. Open pilot studies have indicated that aerosolized iloprost may have beneficial effects in patients with pulmonary hypertension. The effects of aerosolized iloprost on platelet function and plasma cyclic adenosine monophosphate (cAMP) were studied.Platelet aggregation and plasma cAMP were measured at baseline, 30 min, 4 and 6 h after inhalation of 15 µg iloprost in 10 healthy volunteers. Maximal platelet aggregation in response to adenosine diphosphate (ADP) (2 and 6 µmol·L−1), collagen (2.5 and 5 µg·mL−1), epinephrine (1.25 and 5 µmol·L−1) and arachidonic acid (0.5 mg·mL−1) was measured.Platelet aggregation was significantly inhibited at 30 min in response to ADP (2 and 6 µmol·L−1, epinephrine (1.25 and 5 µmol·L−1) and collagen (2.5 µg·mL−1). It was still inhibited at 4 h in response to the same agents, but normalized at 6 h. cAMP increased at 30 min, from 27.3±1.2 to 31.8±1.2 nmol·L−1, remained increased at 4 h (29.2±1.3 nmol·L−1) and normalized at 6 h (27.4±1.1 nmol·L−1).Aerosolized iloprost induced a mild but sustained inhibition of platelet aggregation. Platelet aggregation inhibition may be one of the mechanisms which explains the beneficial effect of repeated inhalation of iloprost in pulmonary hypertension.
Clinical significance of histological classification of idiopathic interstitial pneumonia
Authors: Flaherty K.R. , Toews G.B. , Travis W.D. , Colby T.V. , Kazerooni E.A. , Gross B.H. , Jain A. , Strawderman R.L. , Paine R. , Flint A. , Lynch J.P. , Martinez F.J. 
Published: July 2002

Patients with idiopathic interstitial pneumonias (IIPs) can be subdivided into groups based on the histological appearance of lung tissue obtained by surgical biopsy. The quantitative impact of histological diagnosis, baseline factors and response to therapy on survival has not been evaluated.Surgical lung biopsy specimens from 168 patients with suspected IIP were reviewed according to the latest diagnostic criteria. The impact of baseline clinical, physiological, radiographic and histological features on survival was evaluated using Cox regression analysis. The predictive value of honeycombing on high-resolution computed tomography (HRCT) as a surrogate marker for usual interstitial pneumonia (UIP) was examined. The response to therapy and survival of 39 patients treated prospectively with high-dose prednisone was evaluated.The presence of UIP was the most important factor influencing mortality. The risk ratio of mortality when UIP was present was 28.46 (95% confidence interval (CI) 5.5–148.0; p=0.0001) after controlling for patient age, duration of symptoms, radiographic appearance, pulmonary physiology, smoking history and sex. Honeycombing on HRCT indicated the presence of UIP with a sensitivity of 90% and specificity of 86%. Patients with nonspecific interstitial pneumonia were more likely to respond or remain stable (9 of 10) compared to patients with UIP (14 of 29) after treatment with prednisone. Patients remaining stable had the best prognosis. The risk ratio of mortality for stable patients compared to nonresponders was 0.32 (95% CI 0.11–0.93; p=0.04) in all patients and 0.33 (95% CI 0.12–0.96; p=0.04) in patients with UIP.The histological diagnosis of usual interstitial pneumonia is the most important factor determining survival in patients with suspected idiopathic interstitial pneumonia. The presence of honeycombing on high-resolution computed tomography is a good surrogate for usual interstitial pneumonia and could be utilized in patients unable to undergo surgical lung biopsy. Patients with nonspecific interstitial pneumonia are more likely to respond or remain stable following a course of prednisone. Patients remaining stable following prednisone therapy have the best prognosis.
Mortality in asthmatics over 15 yrs: a dynamic cohort study from 1983–1998
Authors: Connolly C.K. , Alcock S.M. , Prescott R.J. 
Published: July 2002

The Darlington and Northallerton long-term asthma study observes outcome in asthmatics in the light of potential explanatory variables recorded prospectively. This paper reports changes in mortality during the study, and assesses the relevant risk factors.All asthmatics attending secondary care were recruited at 5‐yr intervals from 1983 and reviewed 5 yrs later. Demographic and functional variables, including a formal estimate of best function were recorded prospectively.The dynamic cohort comprised 1,148 asthmatics with 95% follow-up, enabling 612 observations in the period 1983/1988, 774 in 1988/93 and 823 in 1993/98, with 101, 111 and 100 deaths respectively. Principal risk factors for mortality were lower social class and best forced vital capacity. Mortality relative to 1983 halved by 1993/98 and was reduced against the Darlington population, despite an entry forced expiratory volume in one second of 84.7%. There was no change in predictive value of risk factors during the study period, or with date of entry.This study demonstrates a consistent reduction in mortality, which was not entirely a survivor effect, but may be associated with changes in management. By 1993/98 mortality approximated to that of the local reference population despite a lower than predicted forced expiratory volume in one second.
Individual allergens as risk factors for asthma and bronchial hyperresponsiveness in Chinese children
Authors: Wong G.W.K. , Li S.T. , Hui D.S.C. , Fok T.F. , Zhong N.S. , Chen Y.Z. , Lai C.K.W. 
Published: July 2002

The role of allergen sensitization in the development of asthma in the Chinese is not clear. This study aims to determine the relationship of sensitization to individual allergens, and the development of asthma and bronchial hyperresponsiveness (BHR) in schoolchildren from three Chinese cities: Hong Kong, Beijing and Guangzhou.Community-based random samples of 10-yr-old schoolchildren from three Chinese cities were recruited for study using the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II protocol. Subjects were studied by parental questionnaires (n=10,902), skin-prick tests (n=3,479), and methacholine challenge tests (n=608).The prevalence rates of wheeze in the past 12 months (Hong Kong, 5.8%; Beijing, 3.8%; Guangzhou, 3.4%) and atopy (Hong Kong, 41.2%; Beijing, 23.9%; Guangzhou, 30.8%) were highest in schoolchildren from Hong Kong. Multivariate logistic regression analyses revealed that sensitization toDermatophagoides pteronyssinus(odds ratio (OR)=4.48; 95% confidence interval (CI): 3.02–6.66), cat (2.59; 1.67–4.03),Dermatophagoides farinae(2.41; 1.65–3.51) and mixed grass pollen (2.85; 1.24–6.50) were significantly associated with current wheeze. Atopy, defined as having ⩾1 positive skin-prick tests, was not an independent risk factor for current wheeze in children from any of the three cities. Furthermore, atopy (OR=2.53; 95% CI: 1.07–5.97), sensitization to cat (3.01; 1.39–6.52) andD. farinae(3.67; 1.93–6.97) were significantly associated with BHR.The authors confirmed that sensitization to house dust mite and cat was significantly associated with current wheeze and bronchial hyperresponsiveness in Chinese schoolchildren. However, the difference in the prevalence rate of atopic sensitization cannot explain the higher prevalence of childhood asthma in Hong Kong, when compared with those children from Beijing and Guangzhou.
Improved health outcomes in patients with COPD during 1 yr's treatment with tiotropium
Authors: Vincken W. , van Noord J.A. , Greefhorst A.P.M. , Bantje Th.A. , Kesten S. , Korducki L. , Cornelissen P.J.G. 
Published: July 2002

Tiotropium, a novel once-daily inhaled anticholinergic, has been shown to improve lung function over a 24-h period. In order to extend these findings, health-outcomes were evaluated over 1 yr in chronic obstructive pulmonary disease (COPD) patients.Spirometric results, peak expiratory flow rate (PEFR), salbutamol use and effects on dyspnoea, health-related quality of life and COPD exacerbations were assessed in two identical 1-yr randomized double-blind double-dummy studies of tiotropium 18µg once daily (n=356) compared with ipratropium 40µgq.i.d.(n=179).Screening forced expiratory volume in one second (FEV1) were 1.25±0.43 L (41.9±12.7% of the predicted value) (tiotropium) and 1.18±0.37 L (39.4±10.7% pred) (ipratropium). Trough FEV1at 1 yr improved by 0.12±0.01 L with tiotropium and declined by 0.03±0.02 L with ipratropium (p<0.001). Significant improvement in PEFR, salbutamol use, Transition Dyspnea Index focal score, and the St George's Respiratory Questionnaire total and impact scores were seen with tiotropium (p<0.01). Tiotropium reduced the number of exacerbations (by 24%, p<0.01), and increased time to first exacerbation (p<0.01) and time to first hospitalization for a COPD exacerbation (p<0.05) compared with ipratropium. Apart from an increased incidence of dry mouth in the tiotropium group, adverse events were similar between treatments.Tiotropium was effective in improving dyspnoea, exacerbations, health-related quality of life and lung function in patients with chronic obstructive pulmonary disease, and exceeds the benefits seen with ipratropium. The data support the use of tiotropium once-daily as first-line maintenance treatment in patients with chronic obstructive pulmonary disease.
The effect of air pollution on inner-city children with asthma
Authors: Mortimer K.M. , Neas L.M. , Dockery D.W. , Redline S. , Tager I.B. 
Published: July 2002

The effect of daily ambient air pollution was examined within a cohort of 846 asthmatic children residing in eight urban areas of the USA, using data from the National Cooperative Inner-City Asthma Study.Daily air pollution concentrations were extracted from the Aerometric Information Retrieval System database from the Environment Protection Agency in the USA. Mixed linear models and generalized estimating equation models were used to evaluate the effects of several air pollutants (ozone, sulphur dioxide (SO2), nitrogen dioxide (NO2) and particles with a 50% cut-off aerodynamic diameter of 10 µm (PM10) on peak expiratory flow rate (PEFR) and symptoms in 846 children with a history of asthma (ages 4–9 yrs).None of the pollutants were associated with evening PEFR or symptom reports. Only ozone was associated with declines in morning % PEFR (0.59% decline (95% confidence interval (CI) 0.13–1.05%) per interquartile range (IQR) increase in 5‐day average ozone). In single pollutant models, each pollutant was associated with an increased incidence of morning symptoms: (odds ratio (OR)=1.16 (95% CI 1.02–1.30) per IQR increase in 4‐day average ozone, OR=1.32 (95% CI 1.03–1.70) per IQR increase in 2‐day average SO2, OR=1.48 (95% CI 1.02–2.16) per IQR increase in 6‐day average NO2and OR=1.26 (95% CI 1.0–1.59) per IQR increase in 2‐day average PM10.This longitudinal analysis supports previous time-series findings that at levels below current USA air-quality standards, summer-air pollution is significantly related to symptoms and decreased pulmonary function among children with asthma.
Chemokines, innate and adaptive immunity, and respiratory disease: Table 1—
Authors: Sabroe I. , Lloyd C.M. , Whyte M.K.B. , Dower S.K. , Williams T.J. , Pease J.E. 
Published: July 2002

Selective leukocyte trafficking and recruitment is primarily regulated by a specific family of small proteins called “chemokines”. This extended family shepherds and guides leukocytes through their lives, facilitating their development, regulating their interactions with other leukocyte types, and guiding their recruitment to sites of inflammation.Through the actions of chemokines, allergen sensitization is regulated in atopic asthma, through the controlled migration of dendritic cells, T- and B-lymphocytes, mast cells and basophils. Subsequently, atopic inflammation is driven by chemokine-directed recruitment of eosinophils, basophils and lymphocytes. Diseases from cancer to chronic obstructive pulmonary disease to interstitial fibrosis are all potential targets for chemokine receptor antagonism.Innate immunity (the early pattern-recognition responses to stimuli such as lipopolysaccharide, viral proteins and bacterial DNA) needs to bridge the gap to specific immunity and antibody production and immunological memory. Again, chemokines are likely to be fundamental mediators of these responses.Chemokines are fundamental regulators of leukocyte homeostasis and inflammation, and their antagonism by small molecule chemokine receptor antagonists may be of enormous importance in the future treatment of human respiratory disease.
Serological evidence ofLegionellaspecies infection in acute exacerbation of COPD
Authors: Lieberman D. , Lieberman D. , Shmarkov O. , Gelfer Y. , Ben-Yaakov M. , Lazarovich Z. , Boldur I. 
Published: July 2002

A prospective study was conducted to identify and characterize hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with serological evidence of infection withLegionellaspp. (Lsp).Two-hundred and forty hospital admissions for AECOPD of 213 patients were included in the study. Paired sera were obtained for each of the admissions and were tested for 41 different serogroups of Lsp, using microimmunofluorescence-serology. Only a significant change in immunoglobulin‐G and/or immunoglobulin‐M antibody titres was considered diagnostic.In 40 admissions (16.7%) there was serological evidence of infection with Lsp (LspH).Legionella pneumophila1 was identified in nine admissions,L. pneumophila3–15 in 19 and nonpneumophila in 22. In 26 LspH (65%) there was serological evidence of infection with at least one other respiratory pathogen. Compared to the 200 admissions without Lsp (NLspH), the LspH patients were younger (p<0.05) and more hypoxaemic (p<0.04). None of the cases in the LspH group had an abrupt onset of disease, compared to 58 (29.0%) in the NLspH group (p<0.0001). The incidence of myalgia/arthralgia was 55% for LspH compared to 37% for NLspH (p<0.03).To conclude, serological evidence of infection withLegionellaspp. is common among patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease. In most hospital admissions with serological evidence of infection withLegionellaspp. an additional respiratory pathogen can be identified. Acute exacerbation develops gradually in these patients and is characterized clinically by more systemic manifestations than hospital admissions without serological evidence of infection withLegionellaspp. The true interpretation and practical relevance of these findings should be determined in further studies.
Achilles tendon disease in lung transplant recipients: association with ciprofloxacin
Authors: Chhajed P.N. , Plit M.L. , Hopkins P.M. , Malouf M.A. , Glanville A.R. 
Published: July 2002

Achilles tendonitis or rupture are uncommon complications following the use of fluoroquinolones, with a reported incidence in the general population of 0.4%. The aims of the current study were to determine the incidence of Achilles tendon disease (ATD) in lung transplant recipients (LTR) and to identify risk factors.Questionnaires were sent to 150 LTR of whom 101 responded (67%). Twenty-two LTR (21.8%) experienced ATD (tendonitis 16, rupture six). The mean age of LTR who developed ATD was 52.9±6.1 yrs (range: 19–63.5 yrs).Only the use of ciprofloxacin was significantly associated with ATD (p<0.05). Age, sex, underlying disease necessitating transplantation, serum creatinine and cyclosporine levels were not associated with ATD. The association between ciprofloxacin and ATD was not dose related. Of the 72 LTR who had received ciprofloxacin, 20 (28%) developed ATD (tendonitis 15, rupture five). In patients receiving ciprofloxacin, there was no association between the mean cumulative dose of prednisolone and ATD. Tendon rupture occurred with a lower ciprofloxacin dosage than tendonitis and the mean recovery duration was significantly longer.To conclude, lung transplant recipients receiving ciprofloxacin are at significant risk of developing Achilles tendon disease. The association between ciprofloxacin and Achilles tendon disease appears to be idiosyncratic rather than dose-related.
Determinants ofFi,O2with oxygen supplementation during noninvasive two-level positive pressure ventilation
Authors: Thys F. , Liistro G. , Dozin O. , Marion E. , Rodenstein D.O. 
Published: July 2002

To maintain arterial oxygen saturation (Sa,O2) above 90% in patients with acute respiratory failure, oxygen (O2) is often added to the circuit of two-level noninvasive positive pressure ventilation (NPPV). However, the final inspiratory oxygen fraction (Fi,O2) is not known.To clarify this issue, the effect of different inspiratory positive airway pressures (IPAP) of the oxygen tubing connection site and the flow rate of O2, onFi,O2was assessed. The effects of the tidal volume (VT) and the respiratory rate on theFi,O2were then clarified in a model study.TheFi,O2varied depending on the point where O2was added to the circuit. When all other variables were constant, the connection closest to the exhaust port (ventilator side) gave the highestFi,O2. Increases in IPAP led to decreases inFi,O2. Finally,Fi,O2increased with O2flow, although it was difficult to obtain anFi,O2>0.30 unless very high O2flows were used. Paradoxically, NPPV with low IPAP values and without O2supplementation led to aFi,O2<0.21 at the circuit-patient interface.VTand respiratory rate did not appear to influenceFi,O2.To conclude, when using noninvasive positive pressure ventilation with two-level respirators, oxygen should be added close to the exhaust port (ventilator side) of the circuit. If inspiratory airway pressure levels are >12 cmH2O, oxygen flows should be at least 4 L·min−1.