bluuebunny/crossref_metadata_2025_split huggingface dataset:
Computed tomography and magnetic resonance imaging: past, present and future
Authors: Müller N.L. 
Published: October 2002

The aims of this paper are to summarize the current recommendations for the use of computed tomography (CT) and magnetic resonance imaging (MRI) in the chest and to suggest some possible future developments.The main developments of CT in the chest have been the introduction of high-resolution CT (HRCT), spiral CT and, more recently, multidetector spiral CT.HRCT is defined as thin-section CT (1‐ to 2‐mm collimation scans), optimized by using a high-spatial resolution (edge-enhancing) algorithm. Several studies have shown that HRCT closely reflects macroscopic (gross) pathological findings. HRCT currently has the best sensitivity and specificity of any imaging method used for the assessment of focal and diffuse lung diseases.The advent of spiral CT and, more recently, multidetector CT scanners, has allowed for major improvements in the imaging of airways, pulmonary and systemic vessels, and lung nodules. Spiral CT facilitates multiplanar and three-dimensional display of structures and visualization of pulmonary and systemic vessels, with a level of detail that is comparable to that of conventional angiography. With the use of graphics-based software programs, spiral CT enables depiction of the luminal surface of the airways with images that resemble those of bronchoscopy (virtual bronchoscopy) or bronchography (virtual bronchography). Several studies have shown a high sensitivity and specificity for spiral CT in the diagnosis of acute pulmonary embolism. Therefore, spiral CT is rapidly becoming the imaging modality of choice in the diagnosis of pulmonary embolism.Like the radiograph, signal intensity on computed tomography is mainly due to a single parameter: electron density. The signal intensity of the magnetic resonance image depends on four parameters: nuclear density, two relaxation times called T1 and T2, and motion of the nuclei within the imaged lung volume. Abnormal soft tissue can be identified more easily through measurement of these four parameters than through use of computed tomography. Furthermore, because the spatial orientation of the image is determined by manipulation of magnetic fields, scans can be performed in any plane. The main indications for magnetic resonance in the chest have been in the evaluation of the heart, major vessels, mediastinum, and hilar structures because of the natural contrast provided by flowing blood. Of particular interest for the respirologist has been the recent development of magnetic resonance angiography. This technique consists of three-dimensional single breath-hold images obtained using gadolinium-based contrast agents. This is a promising technique for the diagnosis of acute and chronic pulmonary embolism.
The prevalence of asthma and asthma-like symptoms among adults in rural Beijing, China
Authors: Chan-Yeung M. , Zhang L-X. , Tu D-H. , Li B. , He G-X. , Kauppinen R. , Nieminen M. , Enarson D.A. 
Published: October 2002

No data have been reported on the prevalence of asthma in rural areas of China. The objective of the present study was to determine the prevalence of asthma-like symptoms, reported asthma and reported asthma attacks in rural Beijing, China, and to compare the prevalence in 20–44-yr-old participants with those reported for Canada and the European Community Respiratory Health Survey (ECRHS).For a cross-sectional survey, 30 villages were randomly selected in the counties of Shunyi and Tongxian, 50 km north and east respectively of the city of Beijing and within the municipality of Beijing. The International Union Against Tuberculosis and Lung Disease questionnaire on bronchial symptoms translated into Chinese was completed by village doctors for each individual of >15 yrs. The survey was completed by 22,561 individuals, representing 98% of the eligible population.The prevalence of asthma-like symptoms and reported asthma attacks was higher in females than in males and increased with age. Smoking significantly increased the prevalence of symptoms; the effect in females was greater than in males. Among the 20–44-yr-olds, the prevalence of reported asthma attacks in the previous 12 months was 0.67% in rural Beijing, very much lower than that reported in ECRHS centres (3.1%), urban Canada (6.9%) and semirural Canada (5.1%), after adjusting for age and sex. The prevalence of asthma-like symptoms was also very low in rural Beijing compared with ECRHS centres and Canada.It is concluded that the prevalence of asthma-like symptoms and reported asthma was low in rural China compared with other countries, consistent with reports of the relative scarcity of asthma in farms and the “hygiene hypothesis”.
Imaging in lung cancer: positron emission tomography scan
Authors: Vansteenkiste J.F. 
Published: October 2002

In the past 5 yrs, positron emission tomography (PET), usually used with
18
F-fluoro-2-deoxy-glucose (FDG), has become an important imaging modality in lung cancer patients.
Currently, the use of FDG-PET in respiratory oncology is mainly for diagnosis and staging. Standard indications are the evaluation of an indeterminate solitary pulmonary nodule or mass, where FDG-PET has proven to be significantly more accurate than computed tomography (CT) in the distinction between benign and malignant lesions. Several studies have also convincingly demonstrated that locoregional lymph node staging by FDG-PET (in correlation with CT images) is significantly superior to CT, with a negative predictive value equal or even superior to mediastinoscopy. FDG-PET also improves extrathoracic staging, through the detection of lesions missed at conventional imaging or characterization of lesions that remain equivocal on conventional imaging. Many European countries now have or plan reimbursement in these indications. Large-scale randomized studies should now focus on the impact this accurate tumour imaging technique has on treatment outcome and cost-efficacy.
Ongoing studies in specialized centres focus on the use of FDG-PET in more advanced clinical applications, such as planning radiotherapy, response evaluation after radiotherapy or (induction) chemotherapy, follow-up and early detection of recurrence, and prognostic information in this
in vivo
measurement of tumour glucose metabolism.
After a short note on the technique used and a summary of the current common indications of diagnosis and staging, this paper will deal mainly with two of the more advanced clinical applications of FDG-PET in locally advanced nonsmall cell lung cancer: radiation treatment planning and assessment of induction chemotherapy.
Finally, it should be mentioned that a whole new field of applications of positron emission tomography in molecular biology, using new radiopharmaceutical probes, is under extensive investigation. These techniques are promising for future use in very early response monitoring during chemo- or radiotherapy, in evaluation of novel molecular-targeted lung cancer therapies, or even gene therapy.
Role of secretory leukocyte protease inhibitor in the development of subclinical emphysema
Authors: Betsuyaku T. , Takeyabu K. , Tanino M. , Nishimura M. 
Published: October 2002

Secretory leukocyte protease inhibitor (SLPI) is a potent inhibitor of human leukocyte elastase. In some chronic airway diseases, the level of SLPI is decreased in sputum, leading to the continuation of neutrophil inflammation. In this study, the role of SLPI in subclinical pulmonary emphysema was examined.Sequential bronchoalveolar lavage was performed in an attempt to separately evaluate the levels of SLPI in the large airways and in the peripheral airways for two groups of smokers. One group had subclinical emphysema by computed-tomography scans and one group did not. SLPI localized in alveolar macrophages (AM) was also assessed.The level of SLPI was significantly elevated in the peripheral airways from the subjects with emphysema compared to those without emphysema (1589.2±353.9versus729.1±31.0 ng·mL−1), although it was similar in the large airways (3442.3±499.6versus2535.7±578.8 ng·mL−1). There was a trend for higher amount of SLPI to be released from AM in subjects with subclinical emphysema, although this did not reach statistical significance.In conclusion, there is compensatory upregulation of secretory leukocyte protease inhibitor in peripheral airways in subclinical pulmonary emphysema, which is in sharp contrast to the decreased level of secretory leukocyte protease inhibitor reported in some chronic airway diseases.
Ambroxol suppresses influenza-virus proliferation in the mouse airway by increasing antiviral factor levels
Authors: Yang B. , Yao D.F. , Ohuchi M. , Ide M. , Yano M. , Okumura Y. , Kido H. 
Published: October 2002

The protective effect of ambroxol, a mucolytic agent which has antioxidant properties and stimulates the release of pulmonary surfactant, against influenza-virus proliferation in the airway was investigated in mice.Ambroxol or the vehicle was administered intraperitoneally twice a day for 5–7 days to mice shortly after intranasal infection with a lethal dose of influenza A/Aichi/68 (H3N2) virus, and the survival rate, virus titre and levels of factors regulating virus proliferation in the airway fluid were analysed.Ambroxol significantly suppressed virus multiplication and improved the survival rate of mice. The effect of ambroxol reached a peak at 10 mg·kg−1·day−1, higher doses being less effective. Ambroxol stimulated the release of suppressors of influenza-virus multiplication, such as pulmonary surfactant, mucus protease inhibitor, immunoglobulin (Ig)-A and IgG, although it stimulated the release of a trypsin-type protease that potentiates virus proliferation. In addition, ambroxol transiently suppressed release of the cytokines, tumour necrosis factor-α, interferon-γ and interleukin-12, into airway fluid.Although ambroxol had several negative effects on the host defence system, overall it strikingly increased the concentrations of suppressors of influenza-virus multiplication in the airway.
Annual lung function changes in young patients with chronic lung disease
Authors: Merkus P.J.F.M. , Tiddens H.A.W.M. , de Jongste J.C. 
Published: October 2002

Reference equations for ventilatory function that use different statistical models may introduce artifacts that affect the estimated change of lung function during growth in young subjects. The effect of differently modelled reference equations on the estimated annual change of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) in young patients with chronic lung disease was assessed.Four frequently used reference equations were used to describe the longitudinal changes of FEV1and FVC in 52 patients (23 females) with cystic fibrosis (CF) during a mean follow-up of 3.9 yrs.Choice of reference equations directly affected value and, most importantly, estimated annual change of FVC and FEV1. Mean±sd annual change of FEV1varied from 2.2±6.2 to −2.2±3.6% of predicted. For two reference equations the estimated individual changes of FEV1and FVC in CF were positively correlated with mean individual age. This probably reflects underestimation of deteriorating lung function.Variability of annual change was independent of age only when reference equations that were designed to accurately predict lung function during the pubertal growth spurt were used. These findings have implications for patient care and clinical research.
Trends in prevalence of atopic diseases and allergic sensitization in children in Eastern Germany
Authors: Heinrich J. , Hoelscher B. , Frye C. , Meyer I. , Wjst M. , Wichmann H-E. 
Published: October 2002

Trends in prevalence of atopic diseases and allergic sensitization in children from Eastern Germany during the 1990s were analysed.The study consisted of three regional cross-sectional surveys of a total of 7,632 children (aged 5–14 yrs) in 1992–1993, 1995–1996, and 1998–1999. Information was gathered on atopic diseases and potential predictors by a parental questionnaire. Allergic sensitization for birch, grass, mite, cat, and cladosporium were assessed by radioallergosorbent test (RAST).After adjustment for age, sex and the study area of the participants, prevalence increased between the first and third survey for hay fever, for asthma and for atopic eczema. The adjusted prevalence of allergic sensitization (RAST >0.35 kU·L−1) showed a decrease, whereas the prevalence of strong sensitization (RAST ≥17.5 kU·L−1) increased significantly, specifically in cohorts born after 1989. Further adjustment for possible determinants of these atopic diseases did not change the trend estimates.A clear increase in the prevalence of atopic diseases, with the exception of hay fever, was observed as well as a shift towards a stronger allergic sensitization, which might affect the onset of clinical manifestations of atopic diseases.Differences in the epidemiology of respiratory symptoms, illnesses and allergies between populations living in the former East Germany and those living in the former West Germany have been reported. Among East German children, lower prevalence rates of asthma, and positive skin-prick tests were observed compared to West German children in the early 1990s 1–5. Similarly, among East German adults, lower specific immunoglobulin (Ig) E levels and lower prevalence rates of asthma, wheezing, positive methacholine-challenge tests, allergic rhinitis, and positive skin-prick tests have been reported compared to those of West German adults 6, 7.
Glutathione deficiency of the lower respiratory tract in patients with idiopathic pulmonary fibrosis
Authors: Beeh K.M. , Beier J. , Haas I.C. , Kornmann O. , Micke P. , Buhl R. 
Published: October 2002

Idiopathic pulmonary fibrosis (IPF) is a disease of unknown aetiology. Increased oxidant burden and antioxidant,e.g.glutathione (GSH), deficiency in the lower respiratory tract have been thought to play a role in the progression of IPF. Sputum induction is a safe noninvasive tool to study inflammation in the respiratory tract.The aim of the present study was to evaluate the direct measurement of GSH in induced sputum supernatant. Sixteen IPF patients and 15 healthy, nonsmoking subjects underwent sputum induction. Total GSH in sputum, saliva and plasma was measured spectrophotometrically.Sputum GSH was decreased more then four-fold in IPF patients when compared to healthy subjects (mean GSH 1.4±0.34 µMversus5.8±0.98 µM). Salivary GSH was generally low or undetectable in all subjects. Plasma GSH levels were lower in IPF patients (0.26±0.1versus0.74±0.16 µM). In IPF patients, there was a borderline correlation of sputum GSH levels with disease duration and lung-function impairment.These data confirm the established role of oxidant/antioxidant imbalance in the pathogenesis of idiopathic pulmonary fibrosis, and show the potential of induced sputum to directly study inflammatory processes and surrogate markers in interstitial lung diseases like idiopathic pulmonary fibrosis.
The correlation of emphysema or airway obstruction with the risk of lung cancer: a matched case-controlled study
Authors: Kishi K. , Gurney J.W. , Schroeder D.R. , Scanlon P.D. , Swensen S.J. , Jett J.R. 
Published: October 2002

A matched case-controlled study was conducted to determine if airway obstruction or emphysema were associated with an increased risk of lung cancer.Lung cancer cases (n=24) were identified through a low-dose spiral computed tomography (CT) screening trial from 1,520 participants. Four controls without lung cancer were selected for each case from the participants and matched by sex, age and smoking history. Emphysema was assessed by quantitative CT analysis. Conditional logistic regression was employed to assess results of spirometry and CT quantitative analysis as potential risk factors for lung cancer.The likelihood of lung cancer was found to be significantly increased for those with forced expiratory volume in one second (FEV1) ≤40% of predicted. The results suggested that a lower percentage of predicted FEV1was indicative of lung cancer. No compelling evidence was found to suggest that the percentage of emphysema was associated with lung cancer.These results suggest an increased risk of lung cancer associated with airway obstruction. However, percentage of emphysema as determined by computed tomography was not associated with an increased risk of lung cancer.
Contribution of respiratory acidosis to diaphragmatic fatigue at exercise
Authors: Jonville S. , Delpech N. , Denjean A. 
Published: October 2002

The factors that may modulate ventilatory muscle fatigue during exercise are controversial. In this study the contribution of acidosis to exercise-induced diaphragmatic fatigue was investigated, using measurements of the twitch mouth pressure response (tw,Pmo) to cervical magnetic stimulation.After learning sessions, 14 healthy subjects performed two cycling tests (at 60% of maximal aerobic power for 16 min), one while breathing spontaneously (mean minute ventilation (V′e) 67.9 L·min−1) and the other while hypoventilating voluntarily (meanV′E53.8 L·min−1). Exercise was voluntarily set at a moderate power to avoid a fatiguing effect of exerciseper se.As compared with spontaneous breathing (SB), voluntary hypoventilation (VHV) significantly increased mean carbon dioxide tension in arterial blood (Pa,CO2) (51 mmHgversus41 mmHg) and significantly decreased arterial pH (7.28versus7.34). After 10 min of SB test, tw,Pmowas unchanged compared to the baseline value (19.1versus18.5 cmH2O) whereas tw,Pmofell significantly as compared to baseline (17.1versus18.5 cmH2O) and to SB (17.1versus19.1 cmH2O) after the VHV test.The results of this study suggest that exposure to hypercapnia may impair respiratory muscle function. This impairment could be more clinically relevant in patients with chronic obstructive lung disease.
Imaging techniques in treatment algorithms of pulmonary embolism
Authors: Pistolesi M. , Miniati M. 
Published: October 2002

Pulmonary embolism (PE) is more often diagnosedpost mortemby pathologists thanin vivoby clinicians. The identification of practical diagnostic algorithms could reduce the rate of diagnoses first made at autopsy.The literature was reviewed for evidence-based approaches to PE diagnosis. Since the PE mortality rate greatly exceeds that of deep vein thrombosis (DVT), more emphasis was given to reports specifically dealing with PE diagnosis by objective pulmonary vascular imaging techniques than to those aimed at DVT detection.Several studies have shown that standardized clinical estimates can be effectively used to give a pretest probability to calculate, after appropriate objective testing, the post-test probability of PE. A prospective trial has shown that perfusion scanning, rather than ventilation/perfusion scanning, should be the imaging technique of first choice for the management of patients suspected of having PE. The clinical usefulness of spiral computed tomography has not as yet been firmly established. However, ongoing technological developments would probably render the technique accurate enough to replace conventional angiography.The authors propose a noninvasive diagnostic algorithm with high predictive accuracy (positive predictive value 96%; negative predictive value 98%) starting with a standardized assessment of clinical likelihood, followed by a perfusion scan and, eventually, spiral computed tomography in only a minority of patients (<20%) with discordant clinical and scintigraphic findings.
Modern treatment of pulmonary embolism
Authors: Goldhaber S.Z. 
Published: October 2002

Modern treatment of acute pulmonary embolism requires rapid and accurate diagnosis followed by risk stratification to devise an optimal management strategy. Patients at low risk have good outcomes simply with intensive anticoagulation treatment. Higher-risk patients may require more aggressive intervention with thrombolysis or embolectomy.Clinical risk factors for an adverse outcome include increasing age, cancer, congestive heart failure, systemic arterial hypotension, chronic obstructive pulmonary disease and right ventricular dysfunction. A promising approach is the Geneva Prognostic Score, which is based upon a rapid clinical assessment.On physical examination, signs of right ventricular failure, including distended jugular veins and a right-sided S3gallop, should be looked for. The electrocardiogram may show evidence of right ventricular strain with a new right bundle branch block or T wave inversion in leads V1–V4. The troponin level may be elevated as a marker of cardiac injury and right ventricular microinfarction, even in the absence of coronary artery disease. The most useful imaging marker of high risk is the presence of moderate or severe right ventricular dilatation and hypokinesis on the echocardiogram, especially with progressively worsening right ventricular function despite intensive anticoagulation treatment.Patients at high risk should be considered for thrombolytic therapy or embolectomy rather than management with anticoagulation therapy alone. Special care must be taken to avoid thrombolytic therapy among patients who might be susceptible to intracranial haemorrhage. Intracranial haemorrhage reached a surprisingly high rate of 3.0% in the International Cooperative Pulmonary Embolism Registry of 2,454 prospectively evaluated acute pulmonary embolism patients at 52 hospitals in seven countries. An alternative approach to patients at high risk is a catheter-based or open surgical embolectomy. It is crucial to refer these patients as quickly as possible, rather than delaying intervention until cardiogenic shock has ensued. Fortunately the current tools for risk stratification provide an “early window” for prognostication and can help the coordination of a definitive treatment plan with optimal results.
Current surgical treatment of nonsmall cell lung cancer 2001
Authors: Deslauriers J. 
Published: October 2002

Recognizing that surgical treatment is still the best option for controlling lung cancer, surgeons want an operation to be performed when the benefits clearly outweigh the possible risks, and when it has been determined that cancer resection is the most appropriate course of management. The necessity for a compulsive attitude toward preoperative assessment is therefore to be emphasized.Approximately 45% of all lung cancers are limited to the chest, where surgical resection is the most effective method of controlling the disease. Patients with tumour (T) 1, node (N) 0 and T2N0 tumours have early lung cancer, and most are curable by resection, with 5‐yr survival rates in the range 75–80% for patients with T1N0 status. The “gold standard” of surgery remains lobectomy. Stage T1N1 and T2N1 carcinomas represent a group of patients in whom the disease involves hilar and bronchopulmonary nodes. This group is best treated by complete resection and mediastinal lymphadenectomy.Survival data following surgical resection of T3 tumours clearly show better survival in patients with T3N0 disease than in those with T3N1–2 disease. Five-year survival rates for completely resected T3N0 lesions are in the range 30–50%. Once N1 disease is present, survival decreases to 15–20%. Incomplete resections fail to cure and surgery is not indicated if N2 disease is documented preoperatively. On occasion, T4 tumours involving the carina or vertebral body can be completely resected but T4N1–2 lesions are virtually incurable by surgery.The presence of mediastinal lymph node metastasis (N2/N3 disease) is an ominous prognostic sign and stage III‐b disease, by virtue of metastatic contralateral nodes, is an absolute contraindication to surgical resection. Induction treatments with chemoradiation have shown prolongation of survival and three randomized trials have demonstrated a survival advantage over surgery alone.