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PubMed1991

Induced sputum and cytological diagnosis of lung cancer.

Diagnosis of lung cancer by examination of induced sputum specimens for malignant cells may be a valuable alternative to diagnosis by bronchoscopy. Patients suspected of having lung cancer were recruited and randomly distributed into two groups, one group (n = 34) having sputum induced by use of an ultrasonic nebuliser before bronchoscopy, and the other (n = 33) undergoing ordinary expectoration before bronchoscopy. 25 patients in the induced-sputum group were diagnosed as having primary lung cancer; induced sputum was positive for malignant cells in 21 of these patients (84%), whereas bronchoscopy was positive in 23 (92%) (not significantly different). In comparison, ordinary sputum was positive in 15 of 29 patients (52%) diagnosed as having primary lung cancer, whereas bronchoscopy was positive in 28 (97%) (p less than 0.001). Induction of sputum by an ultrasonic nebuliser was an effective procedure for diagnosis of primary lung cancer.

Administration, Inhalation↗
PubMed1993

Efficacy and safety of short-term administration of aerosolised recombinant human DNase I in adults with stable stage cystic fibrosis.

Chronic pulmonary infection is the major cause of morbidity and mortality in cystic fibrosis. High levels of DNA in the sputum make the sputum viscous and difficult to expectorate. Recombinant human deoxyribonuclease (rhDNase) in vitro has been shown to reduce the viscoelasticity of the sputum from CF patients. We have done a phase II double-blind randomised placebo-controlled trial in which patients received either 2.5 mg rhDNase twice daily or placebo for 10 days. All patients had forced vital capacity (FVC) above 40% predicted and were clinically stable. Patients were followed up for 42 days from the start of drug/placebo administration. All 71 randomised patients, aged 16-55, completed every aspect of the study and baseline characteristics were similar in the two groups. Baseline forced expiratory volume in one second (FEV1) was 46% of predicted for patients randomised to rhDNase, and 48% for those randomised to placebo; and baseline FVC was 76% of predicted for both groups. The mean percentage change in FEV1 from baseline was a 13.3% rise on rhDNase and a 0.2% fall on placebo (p < 0.001). FVC rose 7.2% in the rhDNase group and 2.3% in the placebo group (not significant). There were no life-threatening adverse events and no anaphylactic reactions. There was no significant difference in side-effects between the groups. This study confirms that short-term administration of rhDNase in stable patients with cystic fibrosis is safe and improves lung function.

Adolescent↗
PubMed1988

Testing for mutagens in an aluminium plant. The results of Salmonella typhimurium tests on urine from exposed workers.

Urine concentrates from workers in a Söderberg potroom and an anode paste plant were tested for mutagenicity by the Salmonella reversion assay. The study is aimed at group exposure as an indicator of the effect of the work atmosphere. Urine from exposed smokers showed mutagenic activity, whereas urine from exposed non-smokers did not. The mutagenicity of exposed smokers' urine was not significantly different from the urine from non-exposed smokers. Significant mutagenicity of smokers' urine was evident only in the presence of a rat-liver metabolic system. Since an earlier expectorate analysis has shown that mutagens from the work atmosphere are deposited in the workers' respiration system and the urine analysis does not show any effect of occupational exposure, it is likely that the mutagens are eliminated from the body via other routes than renal excretion.

Air Pollutants, Occupational↗
PubMed1992

An occupational health programme for adults and children in the carpet weaving industry, Mirzapur, India: a case study in the informal sector.

The Indo-Dutch Environmental and Sanitary Engineering Project under Ganga action Plan in Kanpur and Mirzapur is being executed within the framework of Indo-Dutch bilateral development cooperation. The project aims to integrate technological, social and health related improvements. It is expected that the development approach and methodology can be replicated in other urban settlements in India. The project is being supplemented by a training and institutional strengthening programme, which will facilitate the transfer of new technologies and improvements in operation and maintenance of these new technologies. One of the project's goals is to improve living conditions in the targeted areas by installing drinking water and drainage systems. A socio-economic unit (SEU) in the project supports these technical interventions by encouraging the community to participate in project activities. The Occupational Health Programme in Mirzapur was conceived by the SEU to improve the health and living conditions of child and adult weavers. At the start of the programme, 200 weavers and 60 non-weaver workers from Mirzapur city, matched for age and socio-economic status, were interviewed and underwent a physical examination. The mean age of the weavers is 27 years, reflecting the relatively large percentage of child labour (13.5%). Illiteracy among them is 73%, whereas 14% have had only a primary education. 64.5% of the carpet weavers are Muslims and 35.6% are Hindus. 61% own a loom or work in a family owned loom shed. 95% of the weavers have a monthly income of less than 600 Rs. Complaints of a persistent cough and cough with expectoration, backache, the common cold and joint pains occurred more often in the weaver population than in the comparison group and have been identified as 'occupational hazards'. An intervention programme has been implemented based on the results of the occupational health survey. These interventions include awareness camps, installment of plexiglass tiles for light improvement in the loom sheds, training of community health volunteers and house-to-house health education. Another essential part of the programme is the provision of functional literacy classes for child and adult labourers in the carpet weaving industry. Occupational health as an entry point proved to be a successful approach in this segment of the informal sector, where child labour plays an important role.

Adolescent↗
PubMed1992

Evaluation of the substantivity of a chlorhexidine oral rinse in irradiated head and neck cancer patients.

A trial was conducted to evaluate the substantivity of chlorhexidine in a population of patients who had undergone primary or adjunctive radiation therapy for tumors of the head and neck. Subjects were instructed to first rinse with 0.12% chlorhexidine as per manufacturer instructions, followed by a releasing rinse provided 1 minute, 1 hour, and 4 hours later. All expectorants were collected, pH adjusted, and introduced to the test microorganism. Zones of bacterial inhibition were then measured and recorded. The results suggest that 0.12% chlorhexidine is retained in the oral cavity for at least 4 hours after an initial rinsing and that the property of substantivity remains active in spite of radiation-induced changes in the oral cavity and salivary glands.

Chemistry, Pharmaceutical↗
PubMed1993

No effects of smoking or drinking habits on salivary amylase.

Nonstimulated and expectorated whole saliva was collected from 166 males and 180 females. To investigate biological effects of smoking and drinking habits on digestive functions in healthy populations, salivary total proteins and amylase activity were determined in the saliva samples. Sex differences in the salivary components were not found. Neither of the two habits had any significant influences on salivary proteins or amylase activity in the subjects. Light to moderate uses of tobacco or alcohol may not influence basal components of saliva.

Adult↗
PubMed1983

Use of a bronchoscopic protected catheter technique in the clinical evaluation of a new antibiotic.

We prospectively compared the usefulness of a bronchoscopic protected catheter technique with the results from sputum cultures in the evaluation of moxalactam, a new beta-lactam antibiotic. The significance of a given isolate on protected catheter culture was determined by quantitative bacteriology. 32 patients with community-acquired pneumonia were enrolled in the study and 31 grew common lower respiratory tract pathogens from their protected catheter specimen. The most common single pathogens recovered were Streptococcus pneumoniae (11 patients) and Haemophilus influenzae (2). Mixed flora, predominantly anaerobes, were isolated from 15 patients, and 3 patients had mixed aerobic infections. All seven bacteremic cases had the identical organism isolated from the protected catheter specimen, confirming the accuracy of the technique. Comparisons with sputum cultures showed that the predominant organism on sputum culture was the same as that obtained from the protected catheter culture in only 13% of the cases. Sputum cultures revealed either no pathogen or a different pathogen in 23 cases, and no sputum could be obtained in 4. Compared to cultures of expectorated sputum, we found the protected catheter bronchoscopic culture technique to have the following advantages in the bacteriologic evaluation of moxalactam: 1) greater accuracy and sensitivity in bacteremic patients; 2) accurate delineation of the bacteriology of infections; and 3) a higher percentage of patients with evaluable bacteriology leading to greater efficiency during the investigation.

Bacteria↗
PubMedDate not supplied

Evaluation of calcofluor white stain for detection of Pneumocystis carinii.

A rapid calcofluor white (CFW) stain for detecting Pneumocystis carinii was evaluated prospectively. Eighty-nine bronchoalveolar lavage (BAL) specimens, 21 open-lung biopsy (OLB) tissues, 2 induced sputums, 1 expectorated sputum, 2 tracheal secretions, and 1 bronchial secretion from 102 patients were examined for P. carinii cysts by both the CFW stain and a modified methenamine silver (MS) stain. Twenty episodes of P. carinii pneumonia were detected: 19 of these episodes were detected by CFW stain, and 16 of those episodes were detected by MS stain. Discrepancies between the two staining methods were resolved by review of the clinical histories and, in one case, by testing an OLB specimen. Neither staining procedure gave false-positive results with any specimen. More cysts were detected in CFW-stained specimens than in MS-stained specimens (p = 0.05). CFW stain is a simple, rapid, and inexpensive method for detecting P. carinii in clinical specimens and is at least as sensitive as MS stain.

Adolescent↗
PubMed1995

Ambroxol inhibits doxorubicin-induced lipid peroxidation in heart of mice.

A single intravenous injection of doxorubicin (DOX, 30 mg/kg body weight) caused a significant rise in the content of lipid peroxidation products in hearts of mice. The concentration of conjugated dienes (CD) and malondialdehyde (MDA) found 24 h after injection of DOX increased about 1.8- and 2.4-fold and reached values of 11.31 +/- 2.24 A233/g and 3.72 +/- 0.40 mumol/g, respectively. The same dose of 4'-epi-doxorubicin (EPI), a less cardiotoxic epimer of DOX, increased only the heart level of MDA. Both antracyclines were not able to induce increased formation of CD in murine liver and lungs. Ambroxol, an expectorant drug which possesses the ability to scavenge hydroxyl radicals, injected intravenously (70 mg/kg) 30 min prior to DOX, completely abolished the rise in heart content of CD and MDA. The heart levels of CD and MDA in animals treated with ambroxol and DOX were 3 and 2.7 times lower than those observed in mice treated with water and DOX, respectively. Ambroxol had no effect on DOX- and EPI-induced formation of MDA in the lungs. Our results indicate that (1) DOX is a more powerful inductor lipid peroxidation in the heart than EPI; and (2) ambroxol may be useful in preventing lipid peroxidation in the heart caused by DOX.

Ambroxol↗
PubMedDate not supplied

Cholelithoptysis: an unusual complication of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is emerging as a preferred surgical method in the treatment of cholecystitis. Decreased morbidity and mortality rates make this an attractive alternative to conventional cholecystectomy. Recently, specific complications including bile duct transection, biloma formation, and liver lacerations have been reported. We report here, however, an unusual case of intraoperative spillage of stones into the intraperitoneal cavity. Subsequent erosion through the diaphragm resulted in expectoration of stones, or cholelithoptysis.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

The roles of HRCT and clinical parameters in assessing activity of suspected smear negative pulmonary tuberculosis.

BACKGROUND: Smear-negative pulmonary tuberculosis (SNPTB) constitutes a major problem in countries with a moderate or high TB prevalence. The value of high-resolution computed tomography (HRCT), chest x-ray and other clinical findings in determining activity of SNPTB were investigated. METHODS: The study population consisted of 85 patients with suspected SNPTB, of whom 52 were confirmed as active pulmonary TB according to either culture positivity for Mycobacteriun tuberculosis or demonstration of caseous granulomatous inflammation. The remaining 33 patients accepted inactive TB sequel. RESULTS: Cough and expectoration were significantly frequent in inactive group whereas chest pain was detected higher in active patients. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of HRCT in detecting disease activity were 88, 88, 92, 83 and 88%, respectively. Centrilobular nodules, other non-calcified nodules, consolidation and cavity were significantly higher on HRCT in active group. Chest x-ray scores that were graded 1 to 3 showed a linear trend for the disease activity. CONCLUSIONS: HRCT has good diagnostic value in detecting activity of SNPTB, and some clinical findings may help in predicting the activity.

Adult↗
PubMed2004

Complicated hydatid cysts of the lung: clinical and therapeutic issues.

BACKGROUND: The clinical presentation and the preoperative and postoperative complications associated with pulmonary hydatid cysts depend on whether the cyst is intact or ruptured. The aim of this study was to review the problems encountered in treating ruptured pulmonary hydatid cysts and to highlight the risks associated with chemotherapy and the delay of surgical treatment in pulmonary hydatid disease. METHODS: The medical records for 67 patients of pulmonary hydatidosis were retrospectively investigated. The patients were divided into two groups based on whether the pulmonary cyst was intact (group 1, n = 34) or complicated (group 2, n = 33). A complicated cyst was defined as one that had ruptured into a bronchus or into the pleural cavity. All patients were treated surgically. Data related to symptoms, preoperative complications, surgical procedures performed, postoperative morbidity, hospitalization time, and cyst recurrence were collected from each individual's records, and the group findings were compared. RESULTS: In most cases of intact pulmonary hydatid cysts, the lesions were either incidental findings or the patient had presented with cough, dyspnea and chest pain. In addition to these symptoms, the patients with complicated cyst had presented with problems such as expectoration of cystic contents, repetitive hemoptysis, productive sputum, and fever. The differences between the groups with respect to the rates of preoperative complications and postoperative morbidity, frequency of decortication, and hospital stay were statistically significant (p < 0.05). CONCLUSIONS: Surgery is the primary mode of treatment for patients with pulmonary hydatid disease. Complicated cases have higher rates of preoperative and postoperative complications and require longer hospitalization time and more extensive surgical procedures than uncomplicated cases. This underlines the need for immediate surgery in any patient who is diagnosed with pulmonary hydatidosis.

Adolescent↗
PubMed2004

Ion-chromatographic determination of carbocisteine in pharmaceuticals based on non-suppressed conductimetric detection.

A novel method for the determination of carbocisteine (S-CMC), a mucolytic and expectorant drug with an acidic amino acid structure, was developed and validated, using non-suppressed ion-chromatographic system with conductimetric detection, and anion or cation exchange columns. Among the various combinations of column type and eluent composition tested, a cation exchange column with a 0.25 mM tri-fluoroacetic acid (TFA) as eluent in isocratic mode at 1.2 ml/min gave the best results. S-CMC was very well separated from all common amino acids (resolution > 2.6). The retention time was 3.5 min and the asymmetry factor 1.1. A linear calibration curve from 17 to 400 microg/ml (r = 0.99994), with a detection limit of 0.14 microg (5.6 microg/ml-25 microl injection volume) and a precision of 1.5% R.S.D. (100 microg/ml, n = 3) was achieved. The proposed method was applied for the determination of S-CMC content in intensely colored commercial formulations (syrups). No interference from excipients was found and the only pretreatment step was the appropriate dilution with the mobile phase. Recovery from standard additions was ranged from 96.0 to 104.9% and precision (R.S.D., n = 3) 1.8-3.6%.

Carbocysteine↗
PubMed2004

Induced sputum in cystic fibrosis: within-week reproducibility of inflammatory markers.

UNLABELLED: Analysis of induced sputum has provided significant insight into the inflammatory response in chronic respiratory diseases such as asthma. The thick, tenacious nature of cystic fibrosis (CF) sputum presents certain challenges to such evaluation. We describe the development of a methodology to assess CF sputum, and the within-week reproducibility (to limit the possibility of any change in clinical status) of cellular and inflammatory markers. METHODS: Seventeen young adults [9 males, 8 females, mean age 24 (5), median (quartile range) years, percentage of predicted FEV(1) = 64.0 (18.0%)] with CF underwent sputum inductions on the Monday and Thursday of the same week. Patients were pretreated with 400 microg salbutamol and subsequently inhaled 5% saline via a breath enhanced nebulizer. Every 3-min nebulization was interrupted to allow for expectoration of sputum into a polypropylene pot. Sputum samples were dispersed with a solution of dithiothreitol (DTT) and deoxyribonuclease to allow for analysis of total cell count (TCC) and percentage neutrophils (%Neut). Measurement of tumor necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8), and neutrophil elastase was performed on samples dispersed with DTT alone. RESULTS: There were no significant differences between the measurements taken in the same week. Values for Day 1 versus Day 2 were as follows: TCC 20.8 (6.4) vs. 17.6 (2.5) x 10(6) cells/ml; %Neut: 94.1 (0.0) vs. 95.4 (0.5) %; TNF-alpha 7.5 (26.0) vs. 21.0 (44.0) pg/ml; IL-8 610.0 (422.0) vs. 524.0 (587.0) ng/ml and neutrophil elastase 110.0 (19.75) vs. 49.75 (60.75) microM. High intraclass correlation coefficients (ICC) for TCC, %Neut, TNF-alpha IL-8 and neutrophil elastase were found (ICC = 0.76, 0.82, 0.93, 0.82, 0.74, respectively). CONCLUSIONS: The method developed here for the analysis of CF sputum shows good reproducibility and can be used to evaluate therapeutic interventions in patients with cystic fibrosis.

Adult↗
PubMed2004

Nocardiosis in a tertiary care hospital on the island of Gran Canaria.

Background: Nocardiosis is an uncommon but serious infection increasingly found in immunosuppressed persons. We describe 14 cases of nocardial infection seen at a tertiary hospital. Methods: All positive Nocardia cultures isolated from 1991 to 2002 were included. We analyzed predisposing factors, epidemiological and clinical features, laboratory and radiological findings, site(s) of infection, antimicrobial susceptibility pattern, treatment, and outcome. Factors related to mortality were analyzed. Results: Nineteen patients with a Nocardia isolate were identified and 14 were finally included. The most common predisposing factors included pulmonary diseases (71.4%), diabetes mellitus (35.7%), systemic diseases (28.6%) and immunosuppressive therapy (28.6%). The site of infection was pulmonary in 12 cases (85.71%), cutaneous or subcutaneous in one case (7.1%), and disseminated in another case (7.1%). The predominant clinical symptom was purulent expectoration (71.4%) while the predominant radiological pattern was a reticulonodular infiltrate (6/12, 50%). Relapse was observed in one case (7.7%) and death in three cases (23.1%). Diabetes mellitus was associated with the mortality rate (p=0.035). Treatment was highly individualized, but trimethoprim (TMP)-sulfamethoxazole (SMX) was the combination most often used. Conclusions: Nocardiosis should be part of the differential diagnosis for patients presenting with pulmonary symptoms, soft tissue infection, or brain abscess.

Journal Article↗
PubMed2006

Platycodin D-induced apoptosis through nuclear factor-kappaB activation in immortalized keratinocytes.

Platycodi Radix is the root of Platycodon grandiflorum and it is widely used in the traditional Oriental medicine as an expectorant for pulmonary diseases and a remedy for respiratory disorders. Platycodin D is the major constituent of triterpene saponins in the root. This study investigates apoptosis by platycodin D in immortalized human keratinocytes (HaCaT). Platycodin D-induced apoptosis in HaCaT cells was confirmed by DNA fragmentation, caspase-3 activation, and caspase-8 activation. Platycodin D could activate inhibitor of nuclear factor-kappaB kinase (IKK)-beta in the nuclear factor-kappaB (NF-kappaB) activation of upstream level, but not IKK-alpha. Pretreated-N-tosyl-l-phenylalanine chloromethyl ketone (TPCK), a potent NF-kappaB inhibitor, could suppress the induction of apoptosis and activation of NF-kappaB of HaCaT cells by platycodin D. We also demonstrated that platycodin D-mediated apoptosis of HaCaT cells upregulates Fas receptor and Fas ligand (FasL) expression, but did not exhibit p53 activation. HaCaT cells were also transfected with pFLF1, which preserves the promoter region of Fas receptor gene containing NF-kappaB binding site. On incubation with platycodin D, the NF-kappaB activity related to Fas receptor increased in a dose-dependent manner. Among the major transcription elements on Fas receptor and FasL promoter, NF-kappaB activation was shown to have an essential role in the expression of the death receptor such as FasL. These results suggest that platycodin D has the ability to induce apoptosis in HaCaT cells through the upregulation of Fas receptor and FasL expression via to NF-kappaB activation in the transcriptional level. These results demonstrate that the NF-kappaB activation plays a crucial role in the induction of apoptosis in human HaCaT cells on treatment with platycodin D.

Animals↗
PubMed2004

Diagnostic test for etiologic agents of community-acquired pneumonia.

Diagnostic tests for the detection of the etiologic agent of pneumonia are neither recommended nor done for most outpatients with CAP (Table 4).Most of these patients have no clear diagnosis but seem to do well with empiric antibiotic treatment, which often costs less than the diagnostic tests. For hospitalized patients, a pre-treatment blood culture and an expectorated sputum gram stain and culture should be done. Testing for Legionella spp is appropriate in hospitalized patients, especially those who are seriously ill. New tests that merit use in selected patients are the urinary antigen assay for S pneumoniae and the PCR test for L pneumophila. Anticipated developments in the near future are PCR tests for detection of C pneumoniae and M pneumoniae.

Bacteriological Techniques↗
PubMed2006

A validated gas chromatographic-electron impact ionization mass spectrometric method for methylenedioxymethamphetamine (MDMA), methamphetamine and metabolites in oral fluid.

An analytical method to simultaneously quantify amphetamine (AMP), methamphetamine (MAMP), methylenedioxymethamphetamine (MDMA), methylenedioxyamphetamine (MDA), methylenedioxyethylamphetamine (MDEA), 3-hydroxy-4-methoxy-methamphetamine (HMMA) and 3-hydroxy-4-methoxy-amphetamine (HMA) in oral fluid is presented. Four hundred microlitres of oral fluid collected via expectoration was extracted by solid phase extraction. GC/MS-EI with selected ion monitoring (SIM) yielded linear curves 5-250 ng/mL for AMP, MAMP, MDMA and MDEA, 5-500 ng/mL for MDA and 25-1,000 ng/mL for HMA and HMMA. Recoveries were greater than 85%, accuracy 87-104%, and precision less than 8.3% coefficient of variation. This assay will be used to investigate distribution of sympathomimetic amines into human oral fluid following controlled drug administration.

Chromatography, Gas↗