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Biomedical subjects

J Boe

Publications and source records attributed to J Boe.

At least 55 records · Page 3Linked to original sources
PubMed1995

Lung function impairment in long-term survivors of Hodgkin's disease.

BACKGROUND: Treatment of Hodgkin's disease (HD) involves radiation and chemotherapy, modalities known to cause lung injury. PATIENTS AND METHODS: In Norway, between 1980 and 1988, 129 patients aged less than 50 years at the time of diagnosis, had curative treatment with thoracic radiation alone or combined-modality therapy for supradiaphragmatic HD. We have examined 116 (90%) of these patients by interview, chest X-ray and lung function tests, 5-13 years after treatment. RESULTS: Nearly 30% of the patients had dyspnoea on exertion and associated reductions in total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and gas transfer (TLCO) (p < 0.05). Radiographic evidence of no, slight or moderate fibrosis occurred in 32%, 54% and 14% of the patients, respectively. Moderate fibrosis was associated with reductions in FVC, FEV1 and TLCO (p < 0.05). Radiation plus chemotherapy containing bleomycin-anthracyclines (median cumulative bleomycin dose 120 mg) was associated with decreases in FVC and TLCO (p < 0.05). In the multivariate analysis, chemotherapy with bleomycin-anthracyclines was the only significant predictor for lung function impairment. CONCLUSION: More than five years after therapy, respiratory symptoms and reduction in lung function were diagnosed in nearly one-third of otherwise healthy HD survivors.

Adolescent↗
PubMed1995

Bronchial responsiveness, eosinophilia, and short term exposure to air pollution.

The number of capillary blood eosinophils and the prevalence of bronchial hyperresponsiveness (BHR) were compared between schoolchildren living in a polluted area (Ardal) and unpolluted area (Laerdal). In Ardal there is an aluminium smelter emitting sulphur dioxide and fluoride to the environment. Daily measurements of these pollutants in ambient air were available. The mean number of eosinophils in Ardal was 220 x 10(6)/l compared with 106 x 10(6)/l in Laerdal. The prevalence of BHR was 15.9% in Ardal and 11.8% in Laerdal. The odds ratio of having BHR in relation to these pollutants during the last 24 hours were: 1.12 (95% confidence interval (CI) 1.01 to 1.24) by increasing sulphur dioxide with 10 micrograms/m3, and 1.31 (95% CI 1.07 to 1.60) when fluoride exposure increased with 1 micrograms/m3. Similarly, these exposures were associated with a decrease in eosinophils of -21 x 10(6)/l (95% CI -36 to -6) and -52 x 10(6)/l (95% CI -98 to -8), respectively, in atopics. It is hypothesised that recent exposure to irritants induces changes in the airways leading to BHR in addition to recruitment of eosinophils to the airways in atopic subjects.

Adolescent↗
PubMed1995

Decreased lung function in one year survivors of allogeneic bone marrow transplantation conditioned with high-dose busulphan and cyclophosphamide.

Conditioning with busulphan (BU) and cyclophosphamide (CY) prior to allogeneic bone marrow transplantation (BMT) is an alternative to regimens that include total body irradiation (TBI). The aim of the study was to assess the occurrence and degree of lung function impairment after this treatment. Prospectively, 43 consecutive patients, aged 17-51 (median 31) yrs, were examined by lung function measurements and clinical and radiographic evaluation, prior to BMT and at 3 month intervals up to 1 yr after BMT. All patients had normal chest radiographs before BMT and at the 12 month follow-up. Mean baseline values were above 100% of predicted normal for lung volumes and above 90% for gas transfer. Excluded from the lung function follow-up analyses were nine patients who had suffered infectious pneumonia and/or developed obliterative bronchiolitis. For the remaining patients (n = 34), mean alveolar volume (VA), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) had dropped by nearly 10% compared with baseline 3 months after BMT, but were restored within 1 yr. FEV1/FVC x 100 (FEV1%) was increased, reflecting the restrictive pattern. Hb-adjusted transfer factor of the lungs for carbon monoxide (TL,CO) had dropped by 20% after 3 months, and remained reduced by 15% after 1 year. Prior to BMT the smokers had significantly lower TL,CO than the nonsmokers, and after BMT the difference was accentuated. Reductions in lung function were independent of sex, age and type of haematological disorder. We conclude that BMT with BU/CY is associated with transient declines in lung volumes and a persistent reduction in gas transfer 1 yr after therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Postnatal maternal smoking increases the prevalence of asthma but not of bronchial hyperresponsiveness or atopy in their children.

We have compared the prevalence of asthma, bronchial hyperresponsiveness (BHR), and atopy in relation to parental smoking in children aged 7 to 13 years. Information on the presence of asthma was obtained from a questionnaire, BHR was assessed by a methacholine challenge test, and atopy was defined as a positive response to a skin prick test. A complete history of the parents' smoking habits during their children's life, including prenatal smoking habits, was recorded. The prevalence of maternal smoking increased from 37.9% during pregnancy to 45.3% at the cross-sectional survey. None of the outcomes was significantly related to paternal smoking, whereas postnatal maternal smoking was positively associated with asthma (odds ratio [OR] = 2.8; 95% confidence interval [CI], 1.3 to 6.1). A negative association between prenatal maternal smoking and atopy was found (OR = 0.6; 95% CI, 0.3 to 0.9). We found no significant association between BHR and parental smoking. Our results indicate that postnatal maternal smoking increases the prevalence of asthma in the offspring without inducing BHR.

Adolescent↗
PubMed1994

Why do our patients die of active tuberculosis in the era of effective therapy?

SETTING: All patients with tuberculosis as a primary or underlying cause of death who were autopsied at the Institute for Lung Diseases and Tuberculosis, Sremska Kamenica, in the former Yugoslavia, between 1981 and 1990 were investigated. OBJECTIVE: To study why people die of active tuberculosis in the era of effective chemotherapy and to identify factors contributing to death. DESIGN: In a retrospective investigation, this index group was compared with a control group consisting of patients who suffered from tuberculosis over the same period but who improved and were discharged from hospital. RESULTS: A significant difference in age (P < 0.05) was found between those patients who died with an antemortem-established diagnosis and those who died with unrecognised tuberculosis (median 49 and 60 years respectively). When it came to the index group, 28 patients (56%) had one or more risk factors and the frequency of alcohol abuse was significantly higher (P < 0.001). Antituberculosis treatment had been introduced in 27 cases (54%). The median duration of hospitalization before therapy was 2 days and the median duration of antituberculosis therapy was 7 days. Of the 23 untreated tuberculosis patients, 74% died within the first 4 days. CONCLUSION: Delay in the detection of tuberculosis was the main factor contributing to death in our patients.

Adult↗
PubMed1994

Deaths from pulmonary tuberculosis in a low-incidence country.

OBJECTIVES: To study the validity of official mortality statistics regarding deaths from pulmonary tuberculosis, and to identify factors contributing to death. DESIGN: A retrospective study. SETTING: Cases were enrolled from the data of the Central Bureau of Statistics from where the official mortality statistics are issued, the National Tuberculosis Register and all Autopsy Registers in the region. SUBJECTS: Case and autopsy reports from all patients who died from active pulmonary tuberculosis in two Norwegian counties between 1977 and 1989. MAIN OUTCOME MEASURES: Patients identified from all three registers with active pulmonary tuberculosis, concomitant diseases/risk-factors, chest X-rays, symptoms, number of patients investigated and treated for tuberculosis, duration from hospital admission until start of treatment and/or death. RESULTS: Ninety-six patients, median age 75 years, died from pulmonary tuberculosis, 51 without treatment. Thirty-four patients had not been registered at the Central Bureau of Statistics. Thirty-nine patients had cough on admission. Weight loss and generalized malaise occurred just as frequently. Forty-two patients had infiltrates on chest X-ray located elsewhere than in the apical region. In 42 patients, no diagnostic tests for tuberculosis were performed. The median length of stay in hospital was 24 days before death in the untreated group, and 21 days before start of treatment in the treated group. CONCLUSION: Reliable figures of patients who died from pulmonary tuberculosis could not be obtained from the official statistics because of under-notification and erroneous codification of diseases. Deaths occurred mainly because the diagnosis was established too late: in half of the patients at autopsy. Eighty-one patients had concomitant diseases known to lower resistance against tuberculosis. Lack of diagnostic suspicion may have been caused by nonspecific symptoms and atypical chest X-ray findings.

Adult↗
PubMed1994

Relation between exposure to fluoride and bronchial responsiveness in aluminium potroom workers with work-related asthma-like symptoms.

BACKGROUND: The relation between plasma fluoride levels and bronchial responsiveness was investigated in a longitudinal study in aluminium potroom workers who reported work-related asthmatic symptoms. METHODS: From a cross-sectional respiratory survey, 26 men who reported work-related asthmatic symptoms on a validated questionnaire were selected for repeated measurements of bronchial responsiveness to methacholine. Regular analyses of plasma fluoride levels were performed. Exposure to fluoride and total particulates was assessed from routine surveillance of the workplace. Bronchial responsiveness was expressed as the dose-response slope of the line through the origin and last data point. RESULTS: A positive association was found between bronchial responsiveness and plasma fluoride levels, such that an increase in the plasma fluoride level of 10 ng/ml was associated with an increase in the dose-response slope by a factor of 1.11 (95% confidence interval 1.05 to 1.17). Plasma fluoride levels were associated with the total atmospheric fluoride concentration in mg/m3 (beta = 28.1), but not with total particulates in the environment. CONCLUSIONS: Bronchial responsiveness in aluminium potroom workers reporting work-related asthmatic symptoms appears to be related to plasma levels of fluoride. The underlying mechanism is, however, unknown.

Adult↗
PubMed1994

Aluminium potroom asthma: the Norwegian experience.

Work-related asthma in aluminium potroom workers, is reviewed and discussed, mainly on the basis of own investigations. The occurrence of work-related asthma has been shown to be associated with the duration of potroom employment, although the prevalence of asthmatic symptoms is not significantly different from that of the general population. Typical manifestations of occupational asthma are described in potroom workers, and a close relationship between the levels of fluoride exposure and work-related asthmatic symptoms has been observed. The existence of occupational asthma in aluminium potroom workers has been confirmed by characteristic patterns of repeated peak flow measurements, supported by changes in methacholine responsiveness in workers with suspected work-related asthma. However, no immunological test is available to establish the diagnosis. Methacholine challenge appears to be inappropriate for screening aluminium potroom workers in order to detect work-related asthma. Current smoking, but not self-reported allergy, is a risk factor for potroom asthma. A family history of asthma and previous occupational exposure may have some effect on the risk of developing symptoms. The prognosis of potroom asthma seems to depend on early replacement to unexposed work. The pathogenetic mechanisms are unknown, although some studies indirectly imply a hypersensitivity reaction. Future studies involving specific bronchial challenge appear to be necessary to find the causal agent(s) of aluminium potroom asthma.

Aluminum↗
PubMed1994

High-dose inhaled steroids in asthmatics: moderate efficacy gain and suppression of the hypothalamic-pituitary-adrenal (HPA) axis. Research Council of the Norwegian Thoracic Society.

We wanted to evaluate the improvement in efficacy when increasing the daily dose of inhaled steroids and to compare the efficacy, safety, and tolerance of 1.6 mg beclomethasone dipropionate (BDP) with that of 2.0 mg fluticasone propionate (FP). The study was a randomized, double-blind, 3 month, multicentre study. One hundred and thirty four asthmatics currently using inhaled steroids (0.4-1.6 mg BDP or budesonide (BUD)) were stratified according to pretrial daily steroid use. Within each stratum they were randomized to either 1.6 mg BDP or 2.0 mg FP. A significant increase in the primary efficacy variables, i.e. mean morning and evening peak expiratory flow (PEF) (approximately 20 l.min-1) during the treatment period, was found for both treatments. No significant differences between the drugs were revealed for these primary or any other secondary efficacy variables (use of beta 2-agonists, symptom scores, and PEF, forced vital capacity (FVC), forced expiratory volume in one second (FEV1) recorded at the clinical visits). However, significant differences between treatments occurred regarding decrease of serum cortisol and adrenocorticotropic hormone. We conclude that, although both treatments gave statistically significant increases in efficacy parameters when compared with baseline, the increases were so small that they can be regarded as being clinically unimportant. Daily doses of BDP, 1.6 mg, and FP, 2.0 mg, had comparable effects on lung function. A suppression of the hypothalamic pituitary adrenal (HPA) axis was only found with a daily dose of 2 mg FP.

Administration, Inhalation↗
PubMed1994

Bronchial responsiveness and decline in FEV1 in aluminium potroom workers.

We have investigated the relationship between annual decline in forced expiratory volume in one second (delta FEV1) and bronchial responsiveness (BR) in aluminium potroom workers. BR was measured in a cross-sectional study of 337 aluminium potroom workers half-way through a 6 yr follow-up study of lung function. A skin-prick test (SPT) was also performed. During follow-up the mean number of measurements of lung function (FEV1) in each subject was 6.8. Mean delta FEV1 was 21.3 ml.yr-1 (within subject SD = 30.5 ml.yr-1). Mean delta FEV1 was 57.0, 44.5 and 16.6 ml.yr-1 in subjects who had provocative concentration producing a 20% fall in FEV1 (PC20) < or = 8.0, 8.1-32.0 and > 32.0 mg.ml-1, respectively. After adjustment for gender, atopy, smoking habit, FEV1, age and familial asthma the association between BR and delta FEV1 was weakened, and was not statistically significant. A significantly accelerated decline in FEV1 with age was found. The difference in delta FEV1 between smokers and nonsmokers was 39.3 ml.yr-1, and between subjects who had a positive skin-prick test compared to subjects with a negative skin-prick test 39.6 ml.yr-1. In subjects reporting work-related asthmatic symptoms the decline in FEV1 was 43.2 ml.yr-1 greater than in asymptomatic subjects. In asymptomatic subjects, positive skin-prick test was also associated with increased delta FEV1. These data indicate that a single measurement of BR is not a predictor of delta FEV1 in aluminium potroom workers. Smoking, work-related asthmatic symptoms, and positive reaction to skin-prick test in asymptomatic workers were risk factors of increased delta FEV1.

Adolescent↗
PubMed1993

[Acute asthma in adults].

Acute asthma can be defined as first appearance of asthma or as a rapid deterioration of the asthmatic's habitual condition which can develop into a life-threatening condition. The severity of an attack and the effect of treatment has to be evaluated with the aid of peak flow measurements. The patient's self-treatment consists of increasing the dose of inhaled beta-2-receptor agonist and eventually doubling the dose of inhaled steroids. First-line treatment in hospital is high-dose inhaled nebulized beta-2-receptor agonist and oral corticosteroids. Ipratropium bromide and theophylline infusions may be added if necessary.

Acute Disease↗
PubMed1993

Interpleural bupivacaine for analgesia during chest drainage treatment for pneumothorax. A randomized double-blind study.

The ability of interpleural analgesia to reduce the pain caused by an indwelling chest drain was evaluated in 22 patients treated for spontaneous pneumothorax. Intermittent 8-hourly bolus injections of 20 ml bupivacaine 0.5% with epinephrine were compared with placebo in a randomized double-blind fashion. Visual analogue pain scale (VAS) scores were registered after the 1st, 2nd, 4th, 7th and 10th injections. The scores were significantly lower in the bupivacaine group at 5, 15, 30 and 60 min after the first injection. No significant differences in pain scores were found after 4 or 8 h. Pain scores in the bupivacaine group were also reduced after the 2nd, 4th, 7th and 10th injections, but compared with placebo the differences were significant only after the 2nd and 7th injections. Parenteral morphine consumption was not significantly lower in the bupivacaine group. Arterial blood gases were unaffected by the treatment in both groups. It is concluded that interpleural analgesia using bupivacaine given as bolus injections at 8-h intervals significantly reduces the pain caused by a chest drain within 5 min of injection, but the duration of pain relief is less than 4 h.

Adolescent↗
PubMed1993

Static lung volumes in healthy subjects assessed by helium dilution during occlusion of one mainstem bronchus.

BACKGROUND: Single lung function is usually assessed by radioisotopes or, more rarely, by bronchospirometry in which a double lumen catheter is used to separate ventilation of the two lungs. The latter is more precise but less comfortable. An alternative bronchoscopic method is described for determining the volume of a single lung. METHODS: One mainstem bronchus was temporarily occluded with an inflatable balloon during fibreoptic bronchoscopy in 12 healthy volunteers aged 18-29 years. The functional residual capacities (FRC) of the right, left, and both lungs were measured in duplicate by closed circuit helium dilution. Supplementary vital capacity (VC) manoeuvres permitted calculation of single lung capacities (TLC) and residual volumes (RV). RESULTS: The standard deviation of a single determination of capacities of the right, left, and both lungs were: TLC, 80, 96, and 308 ml; VC, 56, 139, 171 ml; FRC, 131, 74, and 287 ml; RV, 112, 185, and 303 ml, respectively. The sum of the right and left unilateral TLC was not different from bilateral TLC (6.12 v 5.95 l) and the sum of the unilateral FRC was not different from the bilateral FRC (2.60 v 2.78 l). The sum of the unilateral VC was lower than bilateral VC (4.52 v 4.80 l), that of the unilateral RV was higher than bilateral RV (1.60 v 1.16 l). For all subdivisions of lung volume, the right lung was larger than the left. The most common complaint was substernal discomfort during complete exhalation. Oxygen saturation rarely fell below 90%. CONCLUSIONS: Temporary occlusion of a mainstem bronchus in normal subjects is safe, relatively simple, and allows fairly precise and accurate measurements of unilateral static lung volumes. Occlusion at TLC, however, probably prevents proper emptying of the non-occluded lung.

Adolescent↗
PubMed1993

Chest radiograph--a poor method for determining the size of a pneumothorax.

The ability of chest radiographs to determine the size of a pneumothorax was tested in 16 patients using computed tomographic (CT) scan as a reference method. To determine if CT with a slice thickness of 12 mm could be used, its accuracy was assessed in a lung model experiment. The lung model consisted of a water-filled plastic bag (lung) fitted into a plastic chamber (hemithorax), both of approximately the same size and shape as in man. Water was drawn off in incremental steps and a CT was done after each step. The area of the pneumothorax was calculated by computer and when multiplied by slice thickness and number of slices, the total volume of the pneumothorax could be compared with the extracted amount of water. A good correlation (r = 0.99), with the line of regression close to the line of identity, was found between the CT investigation and the artificial pneumothorax. In the patients, the size of the pneumothorax, judged by radiograph using two different methods of calculation, was correlated to the size obtained by CT. The correlation was poor (r = 0.71) irrespective of method of calculation. The size of the pneumothorax estimated by CT showed a good correlation (r = 0.99) to the initial aspirated air volumes in 12 of the 16 patients treated with drainage. A cautious attitude toward the use of chest radiographs for calculations of the degree of lung collapse in patients with pneumothorax is recommended.

Adult↗
PubMed1993

Daily home spirometry facilitates early detection of rejection in single lung transplant recipients with emphysema.

Eight single lung transplant recipients with emphysema, aged 40-58 yrs, have been followed up for 90 patient months. Starting 2-4 weeks postoperatively, they recorded their forced vital capacity (FVC), and forced expiratory volume in one second (FEV1), at a fixed time every morning using a Micro Spirometer. They were instructed to contact the hospital if the FVC or FEV1 displayed a persistent (two days or more) decrease of 10%, compared with the average values during the last seven days. Transbronchial biopsies (TBB) were performed regularly in the follow-up, and whenever the patients had respiratory symptoms, or the FVC or FEV1 displayed a persistent decline of more than 10%. We performed 59 TBBs, and 23 biopsy specimens showed rejection. The FVC and FEV1 values on the TBB day were compared with the mean values of the 7 previous days. FVC and FEV1, associated with negative TBBs (16 events), showed no significant changes. However, FVC and FEV1 decreased significantly (p < 0.001, paired t-test) during rejections (mean percentage change 14 and 21% respectively, range +8% to -53%). In 16 of the 23 rejections, the FEV1 decreased by > 10%. We recommend the use of daily home spirometry when monitoring single lung recipients with emphysema, and suggest that a persistent 10% decrease in FEV1 or FVC for at least two days is an indication for hospital admission and possible TBB.

Adult↗