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Biomedical subjects

U Costabel

Publications and source records attributed to U Costabel.

At least 109 records · Page 6Linked to original sources
PubMed1994

Elevated surfactant protein A in bronchoalveolar lavage fluids from sarcoidosis and hypersensitivity pneumonitis patients.

Interstitial lung diseases often are accompanied by histopathologic evidence of alveolar type 2 cell alterations. In the alveolar milieu, the surfactant-specific protein A (SP-A) is a secretory product of alveolar type 2 cells. Therefore, we measured SP-A levels in bronchoalveolar lavage (BAL) fluids from patients with untreated sarcoidosis (n = 35) and hypersensitivity pneumonitis (HP [n = 10]) and compared the results with those from 21 healthy control subjects. In sarcoidosis patients, SP-A was markedly higher than in control subjects with a mean of 8.0 micrograms/ml of recovered BAL fluid +/- 0.7 SEM (p < 0.0001 compared with control subjects). In HP, SP-A values were comparable with those in sarcoidosis with a mean of 9.0 micrograms/ml +/- 1.7 SEM. Mean SP-A in the control group was 4.0 micrograms/ml +/- 0.3 SEM. These results suggest that SP-A secretion is stimulated in sarcoidosis and HP. Further studies seem justified to investigate the role of the surfactant system in interstitial lung diseases as well as the potential clinical usefulness of SP-A measurements in BAL.

Adolescent↗
PubMed1994

[Roentgen findings in bronchial tuberculosis].

To determine the value of chest roentgenographic findings in the diagnosis and therapy of endobronchial tuberculosis we analysed roentgenograms of 41 patients with endoscopically confirmed tuberculous involvement of the intrathoracic airways. 40 patients had infiltrates typical for pulmonary tuberculosis predominantly in the upper lobes. Signs of diminished air entry in form of collapse or consolidations were found in 52%. 10 patients had cavities and two had a destroyed lung. In only one patient the chest roentgenogram was completely normal demonstrating a case of isolated endobronchial tuberculosis. During antituberculosis drug therapy radiological signs improved in 38 of 41 patients, but in more than half of the cases stenoses persisted as verified by bronchoscopy. We conclude that endobronchial tuberculosis is usually accompanied by lung parenchyma involvement and that roentgenological findings are characterised by signs of pulmonary tuberculosis in most cases. A normal chest roentgenogram does not exclude endobronchial tuberculosis. Despite roentgenographic improvement during therapy tracheobronchial stenoses may persist. These findings justify to perform early fibreoptic bronchoscopy. Sputum conversion during the clinical course may indicate the most appropriate time for this examination.

Adolescent↗
PubMed1994

[Pulmonary complications after bone marrow transplantation].

Pulmonary complications represent a major cause of morbidity and mortality in patients undergoing allogenic and autologous bone marrow transplantation (BMT). These include a broad spectrum of diseases affecting the lungs and airways, some with predominantly early time of onset (within weeks) and others late (beyond three months) after BMT. The major contributing factors to the occurrence of infectious and noninfectious pulmonary complications of BMT are the state of immunosuppression, secondary to the total body irradiation and chemotherapy used prior to BMT, and acute or chronic graft-versus-host disease. Early and accurate diagnosis by chest roentgenogram, bronchoscopy, and bronchoalveolar lavage combined with appropriate laboratory techniques is essential, as prompt specific treatment clearly has beneficial effects. An increasing number of pulmonary complications appears to be preventable by improving the conditioning regimes, accelerating engraftment and immune reconstitution, prophylactic antibacterial, antimycotic, and antiviral therapy as well as the modification of GVHD therapy.

Bone Marrow Transplantation↗
PubMed1993

[The content of asbestos bodies in the bronchoalveolar fluid as a parameter of an increased pulmonary asbestos load].

Pulmonary asbestos burdens are usually determined by quantitative pulmonary dust analysis. The aim of this study was to investigate the value of bronchoalveolar lavage (BAL) for this purpose. First, the upper limit of normal for asbestos bodies (AB) in BAL fluid was established using a reference group of 371 patients with no evidence of increased exposure to asbestos. 99% of these patients had less than 0.5 AB/ml. In order to see whether BAL fluid AB concentration reflected pulmonary tissue content, BAL fluid and lung tissue from a further 64 patients with diverse histories of asbestos exposure were investigated. There was a positive association between AB concentration in BAL fluid and lung tissue only for the overall group of 64 patients (r = 0.86; P < 0.001). Twelve of 13 patients with more than 1 AB/ml and ten patients with more than 5 AB/ml had more than 1000 AB/cm3 lung tissue, a value that is usually exceeded in asbestosis. When the upper concentration limit was set at 0.5 AB/ml for BAL fluid and 50 AB/cm3 for lung tissue, only two out of 64 patients had a false positive value (specificity 95%), but eleven patients had false negative results (sensitivity 58%). These investigations establish that concentrations of > or = 0.5 AB/ml are a reliable indicator of increased asbestos exposure and concentrations > 1 AB/ml are associated with a higher probability of having more than 1000 AB/cm3 lung tissue. However, exclusion of increased asbestos exposure is not possible on the basis of negative BAL findings, since the sensitivity of the method is too low.

Adult↗
PubMed1993

Bronchoalveolar lavage fluid proteins in human lung disease: analysis by two-dimensional electrophoresis.

Proteins of human bronchoalveolar lavage fluids, obtained by washing the epithelial lining fluid of the lungs with phosphate-buffered saline, were analyzed by two-dimensional electrophoresis under denaturating and reducing conditions. The two-dimensional pattern of bronchoalveolar lavage fluid proteins of healthy volunteers (controls) were compared with those of patients with idiopathic pulmonary fibrosis, sarcoidosis, and asbestosis. Particular interest was paid to the proteins present in minor amounts mainly in the low molecular weight region of the gels. Marked changes in single protein spots were observed. In idiopathic pulmonary fibrosis the spot intensity of the surfactant-associated protein, SP-A, showing isomeric forms both in charge and in molecular weight, was markedly decreased. In sarcoidosis, the immunoglobulins (IgG, IgA) and a group of protein spots at an isoelectric point of 4.5-5.0 and a molecular mass of 55 kDa were increased. An additional spot appeared at an isoelectric point of 4.5 and a molecular mass of 12 kDa. In particular in asbestosis, but also in some cases of idiopathic pulmonary fibrosis and sarcoidosis, the number and intensity of low molecular weight proteins were increased strongly.

Asbestosis↗
PubMed1993

Phenotypic markers of alveolar macrophage maturation in pulmonary sarcoidosis.

The expression of maturation-associated antigens on alveolar macrophages (AMs) was studied in bronchoalveolar fluid of 30 patients with sarcoidosis and 11 control subjects. The percent of AMs expressing CD14 or CD11b (common for blood monocytes) was significantly increased in patients with active sarcoidosis compared to those with inactive disease, and control subjects. On the other hand, the mean expression of antigens characteristic for mature macrophages showed no significant difference (25F9), or was even increased in patients with sarcoidosis (CD71, KiM8). Since CD14 and CD11b molecules were also frequently expressed on large phagocytes morphologically similar to mature macrophages, and recent studies showed modulation of these glycoproteins by the activation of myeloid cells, our data indicate that the majority of AMs recovered by bronchoalveolar lavage in sarcoidosis are mature, activated cells.

Adult↗
PubMed1993

Elevated levels of bronchoalveolar lavage vitronectin in hypersensitivity pneumonitis.

Vitronectin is an adhesive glycoprotein that is present in plasma and the extracellular matrix. Hypersensitivity pneumonitis (HP) is characterized by pulmonary inflammation and damage to the extracellular matrix. Perhaps reflecting this, fibronectin has been found to be elevated in the lower respiratory tract of subjects with HP. Vitronectin, like fibronectin, binds to both extracellular matrix components and cells and may mediate tissue remodeling. Thus, it was investigated whether vitronectin might be increased in bronchoalveolar lavage (BAL) fluid of patients with HP. Vitronectin and, for comparison, fibronectin were measured in BAL fluid from 16 patients with HP and nine healthy control subjects by enzyme-linked immunosorbent assay. Vitronectin was significantly increased in the HP group (658.4 +/- 121.8 ng/ml) compared with the controls (58.4 +/- 11.1 ng/ml, p < 0.001) and was found to be positively correlated with fibronectin. Patients whose last antigenic exposure was 4 or fewer days before the BAL had statistically significantly higher BAL vitronectin and fibronectin than did patients whose last exposure was 5 or more days before the BAL. The serum vitronectin levels did not differ. There was no significant relationship between the lavage fluid vitronectin and fibronectin levels and the BAL cell profile in HP. This study confirms that vitronectin, like fibronectin, is a normal constituent of the lower respiratory tract, and demonstrates that vitronectin is elevated in the lower respiratory tract of patients with HP and may play a role in tissue remodeling and fibrosis in this disease.

Adult↗
PubMed1993

Distribution of asbestos bodies in the human lung as determined by bronchoalveolar lavage.

Asbestos-related lung diseases tend to have distinct local distributions, for example, asbestosis first appears and tends to be more severe in the peripheral parts of the lower lung zones. The risk for asbestosis is related to the total asbestos burden of the lung. This suggests that the lower lobes in asbestos-exposed individuals may contain more asbestos than the other lobes. To test whether such topographic differences exist, we compared the number of retrieved asbestos bodies (AB) per ml BAL fluid in three groups of occupationally asbestos-exposed subjects who underwent BAL at different sampling sites. In Group 1 (n = 24) we performed BAL at three sites, namely in a segment of the right upper, right middle, and right lower lobe, to evaluate differences in asbestos body burden from lung apex to basis. There was a distinct increase in BAL asbestos body concentrations from the upper (21.2 +/- 9.1 AB/ml BAL fluid) to the middle (30.4 +/- 12.8 AB/ml BAL fluid) and to the lower lobe (56.0 +/- 20.2 AB/ml BAL fluid), all differences being significant (p < 0.01). In Group 2 (n = 40), we found good interlobar correlations for asbestos body counts between the right middle lobe (21.0 +/- 5.8 AB/ml BAL fluid) and the lingula (22.4 +/- 5.9 AB/ml BAL fluid) (r = 0.941, p < 0.001) and, in Group 3 (n = 15), between the ventral basal segment of the right (41.2 +/- 13.6 AB/ml BAL fluid) and left lung (39.0 +/- 13.6 AB/ml BAL fluid) (r = 0.966, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Asbestos↗
PubMed1993

Bronchoalveolar lavage procollagen-III-peptide in recent onset hypersensitivity pneumonitis: correlation with extracellular matrix components.

Hypersensitivity pneumonitis (HP) is characterized by the accumulation of inflammatory cells in the lung parenchyma, and may progress to fibrosis. The content of the fibroblast derived collagen metabolite procollagen-III-peptide (PCP-III) in bronchoalveolar lavage (BAL) fluid of HP patients has been found to be increased. Previous studies have shown elevation of the fibroblast adhesion molecules, vitronectin and fibronectin in the BAL fluid of recent onset HP. In view of these observations, it was hypothesized that increases in PCP-III would be associated with increases in vitronectin and fibronectin in the BAL fluid of subjects with untreated recent onset HP. BAL was performed in 14 patients with HP and nine normal controls. The aminoterminal domain of PCP-III was measured by radioimmunoassay, and vitronectin and fibronectin by enzyme-linked immunosorbent assay. Detectable amounts of BAL PCP-III were seen in all HP patients but not in the normal controls (mean +/- SEM 5.1 +/- 1.2 versus < 0.2 ng.ml-1; i.e. below the limit of detection of the PCP-III assay). The BAL fluid concentration of PCP-III correlated well with the amount of vitronectin (r = 0.638) and fibronectin (r = 0.710). Except for PCP-III and mast cells, no significant correlations were found between PCP-III, vitronectin, fibronectin and the cellular parameters. The findings suggest that an increased turnover of collagens and proteoglycans is present in the lower respiratory tract of patients with recent onset HP, possibly reflecting remodelling of the extracellular matrix.

Adult↗
PubMed1993

[Detection of mast cells in bronchoalveolar lavage with various stains].

The study analyzed the value of the May-Grünwald-Giemsa-stain to detect mast cells in bronchoalveolar lavage fluid. 32 consecutive BAL samples were stained with May-Grünwald-Giemsa and with Toluidine blue, a special stain for mast cells. Both stains were equally suitable to detect mast cells in BAL. The Diffquick-stain, however, was not able to stain mast cells in BAL.

Bronchoalveolar Lavage Fluid↗
PubMed1993

The phenotype of alveolar macrophages and its correlation with immune cells in bronchoalveolar lavage.

The phenotype of alveolar macrophages (AMs) is known to be modulated during pathological immune reactions in the lung. In this study, we wanted to determine the relationship between the AM phenotype and changes in the proportions of the various immune cells in bronchoalveolar lavage (BAL). BAL was performed in 76 consecutive patients, including 32 with sarcoidosis, 8 with idiopathic pulmonary fibrosis, 9 with pneumoconiosis, 13 with other respiratory disorders, and 14 controls without evidence of interstitial lung disease. The phenotype of AMs was studied by a panel of 15 monoclonal antibodies against various myeloid antigens, and was correlated with the proportions of cells obtained by BAL. The percentage of BAL lymphocytes showed a relationship with the expression of macrophage antigens in 11 out of 15 antigens studied (all except adhesive molecules CD11a, CD11c, CD18 and the antigen 25F9 present on mature macrophages). Furthermore, the CD4/CD8 ratio of BAL T-lymphocytes correlated with the AM expression of CD54 (intercellular adhesion molecule-1 (ICAM-1)), RFD1 (marker of dendritic cells), and CD71 (transferrin receptor). In samples with an increased number of bronchoalveolar neutrophils, the subpopulation of 27E10 positive AMs (inflammatory acute phase macrophages) was increased. Eosinophils in BAL were not associated with a significant increase in AM membrane antigen expression. Prominent changes of the AM phenotype were found in active sarcoidosis showing lymphocytic alveolitis, with more frequent expression of CD54, KiM2, CD71, CD11b and RFD9. In conclusion, this study shows that the phenotype of AMs is related to the type and intensity of the immunopathological reaction in the lung, and correlates with the proportions of bronchoalveolar cells.

Antigen Presentation↗
PubMed1993

[Recommendations for diagnostic bronchoalveolar lavage. German Society of Pneumology].

The working group "BAL" was established to develop guidelines and recommendations for the practical application of BAL. The indications and complications of the technique are shown, followed by recommendations for the bronchoscopic procedure to collect the samples, for the laboratory processing of the specimen and for the evaluation of the cytological preparations. Guidelines for the interpretation of BAL findings are given. Some normal values from the literature are listed. Disease characteristic changes are presented.

Bronchoalveolar Lavage Fluid↗