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PubMed2000

Eosinophil activation markers in induced sputum in asthmatics.

OBJECTIVES: Eosinophils play an important role in asthmatic airway inflammation collaborately with other inflammatory cells. The present study was aimed to determine whether the eosinophil activation markers in induced sputum reflect the clinical status in asthmatics. METHODS: The clinical severity and FEV1 were measured. Hypertonic saline induced sputum was obtained from 25 asthmatics and ten control subjects. We processed freshly expectorated sputum separated from saliva by treatment with an equal volume of dithiothreitol 0.1%, cytospins for cell count and special stain, and a collection of the supernatant for biochemical assay. We used a fluoroimmunoassay to detect eosinophil cationic protein (ECP), and a sandwich ELISA to detect interleukin (IL)-5. RESULTS: Asthmatics, compared with control subjects, had a significantly higher proportion of eosinophils (25.6 +/- 4.6% vs 1.7 +/- 0.2%, p < 0.01) and higher levels of ECP (1117.8 +/- 213.9 micrograms/L vs 154.6 +/- 47.4 micrograms/L, p < 0.01) in their sputum. IL-5 was detected more frequently in asthmatics than in control subjects [11/25 (44%) vs 1/10 (10%), p < 0.05]. Moderate to severe asthmatics had a significantly higher proportion of eosinophils, higher levels of ECP and IL-5 compared to mild asthmatics. FEV1, FEV1/FVC were significantly correlated with the proportion of eosinophils and the levels of ECP and IL-5. Significant positive correlations were noted between the proportion of eosinophils and the level of ECP and IL-5. Sputum ECP level showed a significant positive correlation with IL-5 level. CONCLUSION: These findings demonstrate that eosinophils and the eosinophil activation markers, such as ECP and IL-5 in induced sputum, are closely related to the clinical status in asthmatics. Induced sputum study may thus be useful in clinically measuring indices of airway inflammation in asthma.

Adult↗
PubMed1995

Utility of a "swish and spit" technique for the collection of buccal cells for TAP haplotype determination.

OBJECTIVE: To demonstrate the utility of a "swish and spit" technique as a nucleated cell source for transporter associated with antigen processing (TAP) haplotype determination by molecular methods in large-scale clinical trials. DESIGN: Twenty normal volunteers were recruited for this prospective feasibility study. From each subject, buccal or blood cells (or both) were collected for use in TAP haplotype assignment by molecular methods and subjected to various storage conditions. MATERIAL AND METHODS: As an alternative to use of lymphocytes obtained by venipuncture, we developed a swish and spit technique for collecting buccal cells for assigning TAP haplotype. For this technique, the subject vigorously swishes isotonic saline in the mouth and expectorates it into a collection container. DNA is extracted from the buccal cells by proteinase K digestion, phenol-chloroform extraction, and ethanol precipitation. In addition, we compared DNA extracted from mouthwash specimens stored under various conditions to which a specimen might be exposed if mailed. RESULTS: DNA extracted from buccal cells obtained by the swish and spit technique provided excellent templates for the polymerase chain reaction (PCR), and subject acceptance of this method was universal. In all cases, assigning TAP haplotype by PCR amplification of specific alleles with use of buccal or blood-derived specimens was successful. The integrity of the specimens was unaffected by storage at -20 degrees C, 4 degrees C, 25 degrees C, or 37 degrees C, and we were able to use the DNA from cells stored under any of these conditions for TAP haplotying. CONCLUSION: We conclude that DNA from buccal cells collected by the swish and spit technique for TAP haplotype assignment is an excellent substitute for DNA obtained from nucleated blood cells, and the technique is useful for large-scale clinical studies that require DNA from subjects geographically distant from the research site.

DNA↗
PubMed2002

Clinical experience of surgical therapy in 207 patients with thoracic hydatidosis over a 12-year-period.

PRINCIPLES: Hydatid disease is the most severe helminthic zoonosis, with a major medical, social, and economic impact in Turkey. The aim of this study was to evaluate retrospectively 207 patients diagnosed with hydatid cyst and treated surgically in our department between January 1990 and December 2001. METHODS: Hundred and ninety three patients were male and 14 female. They ranged in age from 19 to 72 years (mean 25.3 years). The most common presenting symptoms were cough, expectoration and chest pain. The surgical approach was thoracotomy in 198 patients, bilateral staged thoracotomies in 5 patients, median sternotomy in one patient and video-assisted thoracic surgery in 3 patients. RESULTS: Hundred and thirty eight of the 265 intrapulmonary cystic lesions were found in the right lung and 127 in the left lung. Intrathoracic extrapulmonary cystic lesions were detected in 13 patients. 38 patients also had cystic lesions in the liver. Conservative surgical procedures were adopted except for small wedge resections in 8 patients, segmentectomy in 4 patients and lobectomy in one. Operative and postoperative mortality was nil. Albendazole treatment was given to patients who had multiple intrathoracic cysts or additional hepatic cysts after 1994. CONCLUSIONS: Our preferred surgical techniques for removal of cysts were conservative surgical procedures such as enucleation of cysts or removal by cystotomy. Radical procedures such as pneumonectomy, lobectomy and segmentectomy should be avoided as far as possible.

Adult↗
PubMed1988

Health effects due to occupational exposure to cobalt blue dye among plate painters in a porcelain factory in Denmark.

Forty-six plate painters, heavily exposed to cobalt blue dye, took part in this cross-sectional study, and 51 top-glaze painters served as the referents. The study comprised a questionnaire, a health examination, a lung function test, and the determination of the blood and urinary cobalt levels. The plate painters were examined twice, at the end of a workfree period and after resuming work. More plate painters complained of irritation from the mucous membranes in the mouth and throat, cough, and expectoration than the referents. The symptoms increased after the plate painters resumed work. The cobalt level of the plate-painting group after six weeks off work was twice as high in the blood and five times higher in the urine than the corresponding values of the reference group. After the plate painters resumed work, the blood and urinary levels increased approximately 4 and 15 times, respectively. Increased airflow resistance was found in the plate group when compared with the referents, and signs of small airway obstruction increased after the plate painters resumed work. The pulse rate was higher among the plate painters, and minor changes in the red blood cell picture were observed. None of these adverse health effects were associated with the cobalt levels in the blood or urine.

Air Pollutants, Occupational↗
PubMedDate not supplied

Clinical signs, clinicopathological findings, etiology, and outcome associated with hemoptysis in dogs: 36 cases (1990-1999).

Hemoptysis, the expectoration of blood or bloody mucus from the respiratory tract at or below the larynx, was retrospectively evaluated in 36 dogs. Cough, tachypnea, and dyspnea were common historical and physical examination signs. Anemia was documented in 11 dogs, but was severe in only one dog. Other clinicopathological findings reflected the underlying diseases. All thoracic radiographs obtained were abnormal; alveolar and interstitial patterns were most common. Diseases predisposing to hemoptysis included bacterial bronchopneumonia (n=7), neoplasia (n=5), trauma (n=5), immune-mediated thrombocytopenia (n=4), heartworm disease (n=4), rodenticide poisoning (n=3), lung-lobe torsion (n=1), left-sided congestive heart failure (n=1), pulmonary hypertension (n=1), and foreign-body pneumonia (n=1). Four additional dogs had more than one underlying disease process. Nine dogs were either euthanized or died in the hospital during the initial visit. While at least half of the 27 dogs discharged went on to completely recover, five dogs discharged were known to have either died or been euthanized as a result of their disease in <6 months.

Animals↗
PubMed1991

Branhamella (Moraxella) catarrhalis: pathogenic significance in respiratory infections.

OBJECTIVES: To assess the pathogenic significance of Branhamella catarrhalis isolates in patients with respiratory infections and to define the clinical characteristics of such patients. DESIGN AND SETTING: Respiratory specimens were assessed in a three-year prospective study performed in a Brisbane metropolitan hospital. Assessment of the pathogenic significance of isolates of B. catarrhalis was based on four predetermined criteria: (i) clinical evidence of respiratory infection based on history, examination and chest x-ray; (ii) isolation of B. catarrhalis as the sole potential pathogen; (iii) absence of antibiotic treatment in the previous two weeks; and (iv) subsequent clinical response to an antibiotic to which the isolate was sensitive. RESULTS: B. catarrhalis was identified in 118 respiratory samples, 92 (78%) being from patients less than 10 years old. Infection with B. catarrhalis was more commonly seen in winter months and was community-acquired in two-thirds of cases. Isolation of this organism was associated with a broad variety of upper and lower respiratory tract syndromes. Isolates were considered to be of pathogenic significance (all four above criteria satisfied) in 35% of cases and of possible significance (the first and fourth criteria satisfied) in a further 15% of cases. Isolates were more likely to be of pathogenic significance in older patients and in those with pre-existing cardiorespiratory disease; however, a number of serious infections were observed in previously-well children. Expectorated sputum and tracheal aspirates were more likely to yield a clinically significant isolate than nasopharyngeal aspirates. Production of beta-lactamase was demonstrated in 88% of isolates. CONCLUSION: B. catarrhalis causes respiratory infection more frequently than is generally appreciated. Isolation of this organism from the respiratory tract had pathogenic significance or possible pathogenic significance in 50% of our patients. If therapy is indicated in patients with respiratory infection caused by this organism, traditional beta-lactam regimens cannot be relied upon, as shown by the high rate of beta-lactamase production in this study; a tetracycline, erythromycin, a second or third generation cephalosporin, or the combination of a penicillin derivative and beta-lactamase inhibitor should be considered.

Adolescent↗
PubMed1986

Epidemiology and treatment of oropharyngeal gonorrhea.

The natural history, transmissibility, and treatment of oropharyngeal gonorrhea have been incompletely examined in previous studies. We repeated cultures on 60 patients with untreated pharyngeal gonorrhea, before treatment. The probability that the culture would remain positive decreased progressively as the interval between cultures increased, suggesting self-limited colonization. Gonococci were easily grown from expectorated saliva in 34 of 51 cultures from patients with oropharyngeal gonorrhea, suggesting transmissibility and providing another reason for ensuring effective treatment. Five treatment regimens were evaluated in 292 cases of oropharyngeal gonorrhea. Compared with aqueous procaine penicillin G, single-dose ampicillin and spectinomycin had unacceptably higher failure rates, and oral tetracycline given for 5 or 7 days was shown to be effective. A simple oral regimen providing a second dose of ampicillin plus probenecid 8 to 14 hours after the first dose was also effective.

Ampicillin↗
PubMed1975

Primary meningococcal pneumonia.

Three cases of pneumonia caused by Neisseria meningitidis group Y are reported. From the results of these cases, the following conclusions were made. N. meningitidis probably can cause serious infection without preceding blood stream invasion. Primary meningococcal pneumonia is not rare; it has no distinctive clinical presentation; and it may not be recognized by routine expectorated sputum cultures. In addition, it may be associated with recent influenzal and adenoviral infections. Lastly, meningococci of the serogroup Y are capable of causing serious disease. Antimicrobial susceptibility studies showed that all three group Y isolates were sensitive to sulfadiazine and rifampin as well as to penicillin, ampicillin, erythromycin, and chloramphenicol.

Adenoviridae Infections↗
PubMed1979

Rapid diagnosis of Legionnaires' disease by direct immunofluorescent staining.

A blind reading of direct immunofluorescent staining of sputum smears was positive in five of 21 patients with Legionnaires' disease and none of 47 control patients. Positive slides showed from eight organisms per smear (one slide) to 20 to 100 organisms per oil-immersion (magnification, 100) field (three slides). Two of the positive specimens were obtained through an endotracheal tube, one at bronchoscopy, and the other positive slides were from expectorated specimens. In addition, two open-lung biopsies and a bronchial lavage sediment from three confirmed cases of Legionnaires' disease were positive by direct immunofluorescent staining for Legionnaires' disease bacterium.

Fluorescent Antibody Technique↗
PubMed1980

Legionnaires' disease: unusual clinical and laboratory features.

During a nosocomial epidemic of Legionnaires' disease, clinical and laboratory observations led to the recognition of remarkable aspects in six patients. Features included two episodes of disease, dual or sequential infections with Legionella pneumophila and other pathogens; transient deafness with erythromycin therapy, and Legionnaires' disease with a pleural effusion but no pulmonary infiltrate. Expectorated sputum culture yielded two serogroups of L. pneumophila in one patient. Cultures of transtracheal and endotracheal aspirates and of blood led to the diagnosis, permitted evaluation of confounding potential pathogens, and confirmed Legionnaires' disease in the absence of seroconversion. Although many manifestations of Legionnaires' disease were quite typical in this outbreak, these additional unusual features expand the spectrum and illustrate the value of rapid diagnostic methods.

Aged↗
PubMedDate not supplied

[Chronic obstructive bronchitis: definitions, risk factors and prevention (author's transl)].

Chronic obstructive bronchitis is defined as persistent diffuse airways obstruction frequently associated with chronic expectoration. This disease is particularly disabling and its medico-social burden implies that measures be taken. Risk factors of chronic obstructive bronchitis can be classified according to their presently known importance: tobacco, professional exposure, air pollution, viral and bacterial respiratory infections, poor socio-economic and cultural conditions, upper and lower airways infections during childhood, other environmental factors, genetic factors. Prevention needs that research be developed, in particular for factors, as hereditary ones, relations between childhood and adult respiratory diseases and characteristics of the "susceptible smokers". Knowledge of risk factors previously quoted allows to propose public-health actions. Firstly, true preventive action of general nature: fight against tobacco consumption, reduce atmospheric pollution, improve work and life conditions. Secondly, in order to prevent the disabling state of chronic bronchitis, it would be necessary to take care of patients at the initial state. A control trial is proposed to determine the level of symptoms and of reduction of ventilatory values at which an action is needed and the best "preventive therapeutical" protocol to be applied to these patients.

Air Pollution↗
PubMed1999

[A case of tracheobronchopathia osteoplastica discovered incidentally by hypoxemia following the operation].

An 85-year-old woman was found to have tracheobronchopathia osteoplastica incidentally following an operation for left breast cancer. She entered the ICU because of impaired sputum expectoration and hypoxemia. For the purpose of bronchial toilet, bronchofiberscopy was performed under general anesthesia. Numerous nodular elevated lesions were found on all sides of trachea and lobar bronchi except at the membranous part. Transbronchial forceps biopsy showed squamous metaplasia of the mucosa and formation of lamellar bone in the submucosal tissue. The diagnosis was finally confirmed as tracheobronchopathia osteoplastica from these two findings. Although anesthesiologists rarely encounter this disease in their daily practice, it is necessary to keep tracheobronchopathia osteoplastica in their mind as an airway disease.

Aged↗
PubMed1999

[Effective correction of lung hyperinflation in pneumonia using positive end-expiratory pressure].

AIM: Study of PEEP effects on breathing biomechanics in patients with pneumonia. MATERIALS AND METHODS: In 37 patients with pneumonia breathing biomechanics was studied using Masterlab (Jaeger). PEEP (3-10 cm H2O) was employed during 20 min. RESULTS: Sputum expectoration, expiration and inspiration were improved, lung hyperventilation observed in pneumonia reduced after PEEP. CONCLUSION: There is early expiration obstruction of the airways in pneumonia. PEEP removes this obstruction through control of lung hyperinflation. Thus, PEEP can be applied in the treatment of pneumonia.

Acute Disease↗
PubMed1989

The long-term value of the selected list as a method of controlling drug costs in a district general hospital.

The results of a study aimed at evaluating the long-term effects of the Limited List (now officially referred to as the Selected List Scheme) on inpatient drug costs in a district general hospital (DGH) are presented. Study periods of six months duration were examined before, shortly after, and a further year after implementation of the List on 1 April 1985. Eight therapeutic classes affected by the regulations were examined; in four of these (antacids, expectorants, mucolytics and anxiolytics, hypnotics and sedatives) statistically significant reductions in costs were demonstrated over the study periods. There was no significant change in the costs of the other four classes (vitamins, laxatives, nasal preparations and analgesics). Overall, inpatient expenditure for the hospital showed no significant change. The changes in cost demonstrated can be attributed to the Selected List and occurred despite the prior existence of a local formulary.

Cost Control↗
PubMed1998

[Specificity and sensitivity of some signs, symptoms and basic laboratory findings for differentiation between bronchial asthma and chronic obstructive pulmonary disease].

The aim of this study was to asses the importance of the most frequently observed signs and symptoms, as well as commonly used laboratory tests for differentiation between bronchial asthma and chronic obturative pulmonary disease (COPD). Sensitivity(Se) and specificity (Sp) indices were calculated for 140 analysed variables. Sixty one patients diagnosed as having COPD and 89 as suffering from asthma were analysed. For each patient the modified ATS-DLD-75-C questionnaire was filled out, and laboratory tests results were collected. Laboratory findings included: basic spirometry, diurnal PEF variation, bronchodilator tests with salbutamol, ipratropium bromide and corticosteroids, challenges with histamine and exercise, blood gas analysis, skin tests, chest X ray, ECG, blood cell count, blood and sputum eosinophilia. The results obtained have shown that there is no single parameter characterised by specificity and sensitivity that enable to differentiate between the diseases of interest with sufficient accuracy. Sputum expectoration for et least 3 months of the year (Se = 84%, Sp = 69%), smoking index (cigarettes number per day x years of smoking) > or = 200 (Se = 89%, Sp = 74%), have appeared to have the highest sensitivity and specificity for COPD. Most typical of asthma are: intermittent episodes of wheezing (Se = 89%, Sp = 69%), positive bronchodilator tests: with salbutamol (Se--73%, Sp--93%), with ipratropium bromide and with corticosteroids (Se--66%, Sp--94%) and diurnal variation of PEF > or = 20% predicted (Se--64%, Sp--92%). Challenge test with histamine is of limited value for differentiation bronchial asthma from COPD (Se--96%, Sp--40%), while blood eosinophilia, resting spirometry or blood gases are useless for this purpose.

Adult↗
PubMedDate not supplied

[The effect of sex factors on cytologic changes in the sputum of young adults exposed to urban air pollution].

UNLABELLED: The harmful effect of occupational and urban air pollution on the function and structure of the respiratory tract has been proved. The severity and incidence of epithelial changes are in direct relation to duration of exposure and age of the examined population groups [1]. Squamous metaplasia of bronchial epithelium is an indicator of predisposition to chronic obstructive pulmonary disease and lung cancer [1-5]. Due to its topography and the development of industry and traffic, Sarajevo used to be the city with an extremely high level of air pollution [10-12]. Some studies in adults showed that the respiratory tract exposed to air pollution responded with more severe changes in men than in women [7-9]. The aim of this study was to compare cytological changes in sputa, depending on the sex of young adults exposed to a high level of urban air pollution, and to examine whether a big difference in duration of exposure has an effect on these relations. MATERIALS AND METHODS: The subjects in the study were young adults, university students (21 to 25 years of age), all non-smokers. At the time of sputa collection (March-April 1991) they were clinically healthy with no history of chronic and serious acute respiratory diseases. They were divided into two groups according to the duration of air pollution exposure. The first group included those who had been living in Sarajevo since birth. The second group included those who used to live in pollution-free areas, but for the last two to three years had been living in Sarajevo where they came to attend the University (Table 1). Specimens were early morning spontaneously produced sputa, expectorated directly into Saccomanno's fixative and after centrifugation immersed in paraffin. Nine sections from each block were cut and stained with haematoxylin and eosin. The differences between cytological findings were tested with Hi2 test and Fisher's exact test, regarding sex and duration of exposure to air pollution. RESULTS: The findings are summarized in Table 1. As many as 63% and 64% of the subjects from the first and the second group, respectively, were able to produce sputum, while the others produced saliva only. All sputa contained abnormal bronchial columnar cells and half of them contained respiratory spirals (Figures 1 and 2). Squamous metaplastic cells were found in 7% and 9% of subjects in the first and second group, respectively. These cells showed no evidence of atypia. Statistical tests failed to identify significant differences in the incidence of cytological findings between the groups regarding both the sex of the subjects and duration of their exposure to air pollution (Table 2). DISCUSSION: The ability to produce sputum with the frequent presence of respiratory spirals in both groups of our subjects indicate an extremely harmful effect of smog. However, the incidence of squamous metaplastic cell findings was less severe comparing to adults and the elderly urban population. In the elderly (65 to 105 years of age) severe epithelial changes developed spontaneously in the absence of any other known aetiological factor [8, 9]. The increase in severity of changes in the course of aging, in our opinion, due to a gradual decline in efficiency of the defence mechanisms and regenerative potential of the respiratory system. The experimental study showed a decline of the efficiency of mucociliary clearance [14] as well as the damage of the function and decrease in number of alveolar macrophages in lung parenchyma and bronchoalveolar lavage [15, 16]. Trying to answer the question why the sex-related differences in the severity and incidence of epithelial changes appear in the groups of adults and the elderly, it is presumed that in aging the defence and regenerative potentials decline more rapidly in men than in women. (ABSTRACT TRUNCATED)

Adult↗
PubMed1999

[Training program for rehabilitation of patients with internal diseases].

Physical training for patients with internal diseases differs in many points to the physical activity recommended for health maintenance. Cardiac patients are usually limited by symptoms (angina, ECG abnormalities, anaerobic threshold) therefore the intensity of the training (monitored by heart rate or ECG) must be setted by an ergometer exercise testing. Patients with obliterative peripheral artery disease may surpass the local anaerobic threshold during interval-type loads. Blood pressure limits the training intensity of the hypertensive patients if not an organ lesion. COPD patients use the rest periods of an interval training for expectoration and for restitution of their blood gas values. In insulin dependent diabetes the vascular complications can be avoided by a proper insulin regime, training and diet. Day-to-day training by an even energy need acts like the insulin therefore it must be carefully dosed. In NIDDM also the carbohydrate metabolism can improve significantly. In anxiety and depression the training and the social milieu offers a physiological trigger for the improvement. Other rehabilitative interactions (psychology, dietetics, behavioral modalities etc.) are built up in the basis of exercise training.

Cardiac Rehabilitation↗