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PubMedDate not supplied

Bronchoalveolar lavage (BAL) in newly diagnosed patients with collagen vascular diseases.

Collagen vascular diseases (CVD) are commonly associated with interstitial lung diseases. Bronchoalveolar lavage (BAL) fluid analysis has important diagnostic value when considered in conjunction with other information. The present study was undertaken in newly diagnosed patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) at presentation to characterise BAL cellular constituents and elucidate the cellular picture in patients with and without pulmonary symptoms and in those with and without radiological (high resolution computed tomography) features of interstitial lung disease. All the patients were non-smokers and had not received any form of treatment for their diseases. The means of percentages of lymphocytes, neutrophils, and macrophages were 23.3%, 6.2%, 70.5% respectively. There was a significant BAL lymphocyte predominance in patients with pulmonary symptoms, and a lymphocyte and neutrophil predominance in those having radiological evidence of interstitial lung disease.

Adult↗
PubMed2002

[Lung function tests and bronchoalveolar lavage (BAL) findings in patients with primary biliary cirrhosis].

Primary biliary cirrhosis (PBC) is a rare cholestatic liver disease with an autoimmune etiology. The present study was done to estimate the frequency of occurrence of pulmonary disturbances and to analyse the results of bronchoalveolar lavage (BAL) findings in patients with PBC. Thirteen patients (only women) aged 50.4 with histologically proved PBC were investigated. Mean values of lung function tests in the study group were within normal range. In 38% of patients the impairment of DICO was observed. Only in one patient decrease of lung compliance (Cdyn) was observed. BAL findings showed the increase of lymphocytes ratio (> 15%) in 5 patients (38%). The disturbances in lung function and BAL were observed in patients with different stage of PBC and without clinical symptoms of lung disease.

Adult↗
PubMed1992

Bronchopulmonary lavage (BAL). A window of the lungs.

Bronchopulmonary lavage (BAL) has provided a fresh dimension for the investigation of pulmonary and multisystem disorders. BAL fluid may be analysed for cells and chemical mediators in the diagnosis and also serially for the management of several granulomatous disorders including sarcoidosis, extrinsic allergic alveolitis, chronic beryllium disease, talc granulomatosis, tuberculosis, Langerhans' histiocytosis-x and Crohn's disease. It may also provide information in fibrosing alveolitis, collagen vascular disease, occupational and drug-induced lung disease, acquired immune deficiency syndrome, bronchial asthma, neoplasia, transplantation, pulmonary alveolar proteinosis and eosinophilic lung disease. This survey analyses the value of BAL and how it has provided a new window for the chest physician.

Bronchoalveolar Lavage Fluid↗
PubMed2004

BAL cytokine profile in different interstitial lung diseases: a focus on systemic sclerosis.

BACKGROUND AND AIM: Fibrosing alveolitis develops in up to 80% of systemic sclerosis patients (SSc) but progression to end stage fibrosis occurs in about 15% of cases. Mechanisms leading to the process remain mostly unknown. We compared cytokine profiles of broncho-alveolar lavage fluids (BAL-f) from patients with SSc associated interstitial lung disease (SSc-ILD) (n. 34), idiopathic pulmonary fibrosis (IPF) (n. 13), stage II sarcoidosis (n. 14) and 9 controls. METHODS: Interleukin (IL) 8, monocyte chemoattractant protein 1 (MCP-1), gamma-interferon (IFN-gamma), IL12, IL18 and IL10 and transforming growth factor-beta (TGF-beta) were assessed by ELISA in concentrated BAL-f. RESULTS: Levels of IL8 and MCP-1 were significantly elevated in SSc-ILD and in IPF as compared with controls (Mann Whitney test p < 0.05), while MCP-1 values were significantly lower in SSc-ILD than in IPF. A significant correlation between neutrophils and IL8 levels (p = 0.047), as well as between eosinophils and MCP-1 levels (p = 0.004) was also observed. IFN-gamma levels were slightly higher than normal only in sarcoidosis (p = 0.06), whereas IL12 levels increased both in sarcoidosis and SSc-ILD (p < 0.05). No differences were found in IL18 and TGF-beta levels. Finally, IL10 levels were higher in SSc-ILD and sarcoidosis than in controls and IPF (p < 0.05). CONCLUSION: BAL-f cytokine profile differentiates ILD associated with SSc from IPF. The lower expression of MCP-1 and the higher expression of the anti-fibrotic IL12 and the anti-inflammatory IL10, observed both in sarcoidosis and in SSc-ILD, could account for the better prognosis of these ILDs. Further longitudinal studies are required to confirm whether a different cytokine phenotype may be considered predictive of clinical outcome in SSc-ILD.

Adult↗
PubMedDate not supplied

[The role of bronchoalveolar lavage (BAL) in assessing pulmonary compromise in AIDS].

The severe immunologic alterations caused by HIV infection is at the base of respiratory tract infections, neoplasms and inflammatory complications which represent the most frequent cause of death in AIDS patients. The etiological diagnosis is difficult and often needs invasive procedures. Among those, BAL is surely the most useful method because of its lesser invasiveness and better tolerability and more for its sensibility and easier repeatability. Besides the etiological evaluation of lung infections, BAL allows to obtain and analyze immunologic and inflammatory cells from alveolar spaces consenting the acquisition of data regarding immunopathogenetic mechanisms related to pulmonary complications during AIDS. We report data about cytoimmunologic study of BAL fluid in 10 patients of ours.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Diagnostic role of BAL in pulmonary alveolar microlithiasis].

From 1982-90, 3721 fiber bronchoscopies were performed for the diagnostics of diffused alveolar-septal pathologies; BAL was performed in 400 cases. Alveolar pulmonary microlithiasis was diagnosed in 6 patients, and two of them were related. The staging and the evolution of the pathology were evaluated as follows: chest x-ray in various projections, calcemia, lung function tests, fiber bronchoscopy with analysis of BAL and quantitative evaluation of macrophagic and lympho-monocytic elements and in percentage of calcosferitics. Four patients were treated with therapeutic BAL in the lungs with normal saline, and the cytological results and the percentage of calcosferitics were monitored for 24 months.

Adolescent↗
PubMed1990

[Two cases of bronchiolitis obliterans organizing pneumonia, showing multiple infiltrative shadows, diagnosed by open lung biopsy, and a report of their BAL findings].

Two cases of bronchiolitis obliterans organizing pneumonia (BOOP) were diagnosed by clinical features and pathological findings of open lung biopsy specimens. Findings of repeated (bronchoalveolar lavage (BAL) fluid analysis were also reported. Case 1 was a 54 year-old woman complaining of dry cough and low grade fever. Multiple infiltrative shadows in both lung fields were pointed out on her chest roentgenogram. Case 2 was a 68 year-old woman with symptoms of cough, sputum and low grade fever. Her chest X-ray films also showed multiple infiltrative shadows bilaterally. Although various antibiotics were given to both patients, new shadows appeared on their chest films without any improvement of clinical symptoms or inflammatory findings. TBLB specimens obtained from the two cases showed the findings of organizing pneumonia. In each case, open lung biopsy was performed, and the pathological diagnosis was consistent with BOOP. However, exclusion of the possibility of eosinophilic pneumonia and lymphoproliferative disorders of the lung was somewhat difficult in case 1. BALF analysis showed an increased number of lymphocytes in both cases, 75% and 37% respectively. The inverted ratio of OKT4/OKT8 (0.71) in BALF of case 1 was similar to that of hypersensitivity pneumonitis. In spite of clinical and roentgenological improvement after steroid therapy, the abnormal BAL findings still remained. Therefore it is suggested that BAL may be a useful tool for monitoring the steroid treatment of patients with BOOP.

Aged↗
PubMed1989

Usefulness of the analysis of broncho-alveolar lavage (BAL) cellular composition in diagnosis and monitoring of pulmonary sarcoidosis treatment.

The paper presents the results of the analysis of BAL composition in 45 patients with diagnosed pulmonary sarcoidosis in various phases of its development. The examination was performed before the treatment, in the 6th week and 3rd month of the treatment and after its termination. In the treatment encorton was applied for 2 years. In the analysis of cell composition of the lavage the percentage of lymphocytes, macrophages and granulocytes was calculated. Before the treatment the high percentage of lymphocytes occurred along with relatively diminished percentage of macrophages. The highest lymphocyte level was noted in the pulmonary phase of sarcoidosis which amounted to 58.8 +/- 15.5 and the lowest in the nodulary phase 38.5 +/- 14.1. In the 6th week of the treatment BAL cell composition approached the control value. The results obtained hereby evidence that the changes in BAL cell composition may be successfully applied in the diagnosis, dynamics of development and monitoring of sarcoidosis treatment.

Adult↗
PubMed1989

Special neutrophil elastase inhibitory activity in BAL fluid from patients with silicosis and asbestosis.

Pneumoconiosis is defined as the disease resulting from a chronic exposure to different inorganic dusts. In order to assess the lung defence against the effects of dust exposure, we studied the bronchoalveolar lavage (BAL) fluids from 30 silicotic patients (9 of them having a diagnosis of progressive massive fibrosis (PMF)) and 8 subjects with a diagnosis of asbestosis. Total protein content, N-acetyl-beta-D-glucosaminidase activity, free elastase-like activity, immunoreactive alpha 1-proteinase inhibitor (alpha 1PI) and neutrophil elastase inhibitory capacity (NEIC) were determined, and the values obtained were compared to those of 14 control BAL fluids. In all of the patients, our data showed a significant increase of total protein content and free elastase-like activity. In contrast, N-acetyl-beta-D-glucosaminidase activities did not reach statistical significance. Values concerning immunoreactive alpha 1PI and NEIC were significantly raised only in patients with PMF and with asbestosis. When the ratio NEIC/immunoreactive alpha 1PI was calculated, a significant difference was noticed in the asbestosis group; on the other hand, this ratio was significantly reduced in the group of PMF patients. After neutrophil elastase addition, an electrophoretic study by SDS-PAGE and immunoblotting was carried out; it showed more proteolysed alpha 1PI in the BAL fluids having a lowered NEIC/alpha 1PI ratio. These facts could be explained by the presence of inhibitors of neutrophil elastase different from alpha 1PI.

Acetylglucosaminidase↗
PubMedDate not supplied

Immunobiochemical evaluation of bronchoalveolar lavage (BAL) in atopic bronchial asthma, chronic bronchitis and bronchiectasis.

The protease-antiprotease balance and concentration of immunoglobulin was evaluated in some respiratory tract diseases. Analysis was carried out on 24 patients with atopic bronchial asthma, 21 with chronic bronchitis, 27 with bronchiectasis and 18 healthy smokers volunteers. In examination of BAL fluid some selective changes of proteolytic enzymes activities and concentrations of their natural inhibitors were documented. In atopic bronchial asthma the increased activity of acid protease, acid phosphatase and concentration of alpha-2-macroglobulin was the most characteristic. In chronic bronchitis there was an increase of acid protease, alkaline phosphatase and concentration of alpha-1-antitrypsin, haptoglobin, but in bronchiectasis the increase of neutral and acid proteases activities and concentration of all examined natural inhibitors was noted. The changes in concentration of IgA and IgG confirmed their participation in local defense response. All examined BAL enzyme activities and concentrations of inhibitors and immunoglobulins were compared with the results of the parameters in serum, mentioned above. The obtained finding supports the suggestion that the proteolytic enzymes, their natural inhibitors and immunoglobulins play an important role in the respiratory tract pathology. Immunobiochemical analysis of BAL in atopic bronchial asthma, chronic bronchitis and bronchiectasis may be useful for clinical prognosis and pharmacological treatment.

Adolescent↗
PubMed1994

[Specificity of surface antigen and function of BAL T cells].

To elucidate the pathogenesis of sarcoidosis, we mainly investigated the surface molecules including adhesion molecules on BAL T cells and the functions of BAL T cells such cytokine production, [Ca2+] mobilization, PKC expression. Results are following. Adhesion molecules were up-regulated on BAL T cells compared with peripheral T cells, but cytokine production was decreased via TcR stimulation through [Ca2+] mobilization was occurred. PKC isozyme alpha expression was decreased compared with peripheral blood T cells.

Antigens, Surface↗
PubMed1996

Pig farmers have signs of bronchial inflammation and increased numbers of lymphocytes and neutrophils in BAL fluid.

The purpose of this study was to investigate whether pig farmers had inflammation of the bronchial mucosa and activation of bronchoalveolar lavage (BAL) cells. Pig farmers are exposed to high dust levels and have a prevalence of work-related respiratory symptoms. Bronchoscopy and BAL were performed in 27 young large-scale pig farmers, who had never smoked. Fifty three lifetime nonsmoking healthy students participated as controls. All farmers and controls had normal lung function (forced expiratory volume in one second (FEV1) 109 and 105% predicted respectively. Estimation of macroscopic signs of inflammation in the bronchi (erythema, oedema, secretion and friability) showed that pig farmers had significantly increased signs of inflammation. The median score was 3 (range 0-6) compared to a median score of 0 (range 0-3) in controls. More pig farmers than controls (41 versus 25%) had a positive histamine challenge (provocative dose producing a 20% fall in FEV1 (PC20) < or = 32 mg.mL-1) but the difference was not significant. The cell concentration in BAL fluid was identical in the two groups. Pig farmers had a significantly increased percentage of lymphocytes (median 7, range 1-27 versus median 2, range 0-7) and neutrophils (median 2, range 0-30 versus median 1, range 0-4) compared to controls. Spontaneous migration (19.8 versus 5.5 microns) and chemotaxis (62.6 versus 11.2 microns) was significantly increased in pig farmers compared to controls. After stimulation with zymosan and phorbol myristrate acetate (PMA), the reactive oxygen radical generation of purified alveolar macrophages was also significantly increased in pig farmers. Lifetime nonsmoking pig farmers with normal lung function have macroscopic signs of bronchial inflammation and an increased number of neutrophils in bronchoalveolar lavage. Their alveolar macrophages showed biological signs of activation. The inflammation of pig farmers bronchi may be early signs of bronchitis.

Adult↗
PubMed1997

Quantitative and morphological changes in BAL-isolated cells after the administration of TNF-alpha into Morris hepatoma.

The aim of this study was to explore the effect of intratumor TNF-alpha administration upon the composition and adherence degree of cells isolated from the lungs through multiple bronchoalveolar lavages (BAL). Ultrastructural evaluation of BAL-isolated cells was performed in the scanning electron microscope (SEM). The experiment used Buffalo rats. A suspension of 3 x 10(6) cells of Morris hepatoma (5123 series) was injected to the right hind leg of the animals. After fourteen days, TNF-alpha was administered into the tumor in a dose of 1.5 x 10(4) U in 0.5 ml PBS solution. The animals of group I were given 4 doses of TNF-alpha and group II-8 doses of TNF-alpha every 24 hours. Control groups consisted of rats with injected Morris hepatoma which were given PBS solution instead of TNF-alpha (group III A, B) and animals without the hepatoma, given intramuscullary 4 or 8 TNF-alpha, respectively (groups IV A, B). No statistically significant differences were noticed between groups I and II with regard to the number of macrophages and neutrophils isolated from the rat lungs compared with control group IV. However, such differences were observed compared with group III. In group II and IV B, an increase in the adherence of isolated cells was found compared with group III, as well as arise in the number of macrophages with the largest diameters. We found a correlation between the increase in cell adherence and ultrastructural changes (in SEM) suggesting an increased activity of BAL-isolated cells.

Animals↗
PubMed1997

Analysis of asbestos bodies in BAL from subjects with particular exposures.

Four patients with asbestos-related diseases and with unusual exposures underwent bronchoalveolar lavage (BAL) for mineralogical analysis. Asbestos bodies (AB) were counted by light microscopy and analyzed by transmission electron microscopy and X-ray energy spectrometry. AB's were found in all cases, after a mean delay from the end of exposure of 27.7 years. Analysis of the core fibers indicated the type of alveolar asbestos burden and was compared with the previous exposures: Pleural plaques due to household exposure to amosite and crocidolite. Pleural plaques due to occult occupational exposure to crocidolite in a coal miner. Asbestosis due to environmental exposure to tremolite in Turkey. Asbestosis, pleural plaques, and peritoneal mesothelioma due to a short, intense exposure to crocidolite. AB counting in BAL and identification of the central fibers by analytical electron microscopy is a useful, non-invasive and reliable method to evaluate the alveolar retention of bio-persistent fibers and to relate them to specific exposures.

Aged↗
PubMed1997

Rapid diagnosis of acute eosinophilic pneumonia (AEP) in a patient with respiratory failure using bronchoalveolar lavage (BAL) with calcofluor white (CW) staining.

A diagnosis of exclusion, acute eosinophilic pneumonia (AEP) is an acute febrile illness with respiratory impairment, diffuse pulmonary infiltrates, and bronchoalveolar lavage (BAL) fluid eosinophilia. Whether pulmonary eosinophilia in AEP is primary or secondary remains undetermined. We report here a 22-year-old auto mechanic with severe AEP and acute respiratory failure who required intubation and ventilatory support. The patient's bronchoalveolar lavage (BAL) fluid was analyzed using cultures, cytology, Wright/Giemsa, Gram, Gomori-methenamine-silver (GMS), and calcofluor white (CW) stains (1). Despite extensive evaluation, no infectious etiology was found. CW staining helped us rapidly to exclude Pneumocystis carinii or fungal infection and to focus attention toward the diagnosis of AEP. Transbronchial biopsy was unnecessary and supportive therapy without systemic glucocorticoids was followed by recovery within a few weeks. In this case, bronchoalveolar lavage with CW staining was of great assistance in the rapid diagnosis and initial management of AEP. Our literature review found no prior article using CW staining for evaluation of AEP.

Acute Disease↗
PubMed2005

Backbone amide linker (BAL) strategy for Nalpha-9-fluorenylmethoxycarbonyl (Fmoc) solid-phase synthesis of peptide aldehydes.

A rapid and efficient strategy has been developed for the general synthesis of complex peptide aldehydes. N(alpha)-Benzyloxycarbonylamino acids were converted to protected aldehyde building blocks for solid-phase synthesis in four steps and moderate overall yields. The aldehydes were protected as 1,3-dioxolanes except for one case where a dimethyl acetal was used. These protected amino aldehyde monomers were then incorporated onto 5-[(2 or 4)-formyl-3,5-dimethoxyphenoxy]butyryl-resin (BAL-PEG-PS) by reductive amination, following which the penultimate residue was introduced by HATU-mediated acylation. The resultant resin-bound dipeptide unit, anchored by a backbone amide linkage (BAL), was extended further by routine Fmoc chemistry procedures. Several model peptide aldehydes were prepared in good yields and purities. Some epimerization of the C-terminal residue occurred (10% to 25%), due to the intrinsic stereolability conferred by the aldehyde functional group, rather than any drawbacks to the synthesis procedure.

Aldehydes↗
PubMed1983

BAL increases the arsenic-74 content of rabbit brain.

The 74As content of the brain of rabbits was doubled following administration of BAL (2,3-dimercapto-1-propanol). DMPS (2,3-dimercapto-1-propanesulfonic acid, sodium salt), however, decreased the rabbit brain arsenic concentration. The use of BAL as the drug of choice for treatment of arsenic intoxication should be viewed with caution and re-examined.

Animals↗