Lung Diseases Research Papers - Academia.edu (original) (raw)

As healthcare delivery changes in critical care, nursing continues to extend its practice base. Nursing practice is expanding to incorporate skills once seen as the remit of the medical profession. Critical care nurses are equipping... more

As healthcare delivery changes in critical care, nursing continues to extend its practice base. Nursing practice is expanding to incorporate skills once seen as the remit of the medical profession. Critical care nurses are equipping themselves with evidence-based knowledge and skills that can enhance the care they provide to their patients. Assessment of patients is a major role in nursing and, by expanding assessment techniques, nurses can ensure patients receive the care most appropriate to their needs. Nurses in critical care are well placed to perform a more detailed assessment which can help to focus nursing care. This article describes the step-by-step process of undertaking a full and comprehensive respiratory assessment in critical care settings. It identifies many of the problems that patients may have and the signs and symptoms that a nurse may note whilst undertaking the assessment and preparing to prescribe care.

Neutrophil infiltration into inflammatory sites is one of the hallmarks of acute inflammation. Locally produced chemotactic factors are presumed to mediate the sequence of events leading to the infiltration at inflammatory sites.... more

Neutrophil infiltration into inflammatory sites is one of the hallmarks of acute inflammation. Locally produced chemotactic factors are presumed to mediate the sequence of events leading to the infiltration at inflammatory sites. Interleukin-8 (IL-8), a novel leukocyte chemotactic activating cytokine (chemokine), is produced by various types of cells upon stimulation with inflammatory stimuli and exerts a variety of functions on leukocytes, particularly, neutrophils in vitro. However, no definitive evidence has been presented on its role in recruiting and activating neutrophils in the lesions of various types of inflammatory reactions. We administered a highly specific neutralizing antibody against IL-8 in several types of acute inflammatory reactions, including lipopolysaccharide (LPS)-induced dermatitis, LPS/IL-1-induced arthritis, lung reperfusion injury, and acute immune complex-type glomerulonephritis. Anti-IL-8 treatment prevented neutrophil-dependent tissue damage as well as ...

Three sources of halitosis exist, potentially in any combination: mouth, nasal cavity or alveolar breath. There has been no universally accepted protocol which differentiates and quantifies each odour source separately. In this study a... more

Three sources of halitosis exist, potentially in any combination: mouth, nasal cavity or alveolar breath. There has been no universally accepted protocol which differentiates and quantifies each odour source separately. In this study a new gas measurement protocol is described and tested to determine whether each odour source can be separately detected without contamination. Ninety healthy volunteers were divided into three groups. Hydrogen sulphide (H2S), volatile organic compounds (VOCs) and hydrogen (H2) were artificially generated in the mouth, nose and pulmonary alveoli, respectively. VOC, ammonia (NH3), sulphur dioxide (SO2), H2S and H2 gas readings from mouth, nose and alveolar air were measured and compared. Measurements were taken before and during gas generation. Contamination of nasal air (2.8%) and alveolar air (5.0%) by oral H2S; alveolar air (2.06%) and oral air (4%) by nasal organic gas; nasal air (18.43%) and oral air (9.42%) by alveolar H2 was calculated. The result...

lntrapulmonary percussive ventilation (IPV) is a novel form of chest physiotherapy delivered by a percussive pneumatic device (IPV, Percussionaire, Sand Point, ID). There are few published reports about the use of IPV for diseases other... more

lntrapulmonary percussive ventilation (IPV) is a novel form of chest physiotherapy delivered by a percussive pneumatic device (IPV, Percussionaire, Sand Point, ID). There are few published reports about the use of IPV for diseases other than cystic fibrosis. We report our experience with three pediatric patients and one adult patient with persistent pulmonary consolidation refractory to conventional therapies. Three of the four patients had neurornuscular disease; one patient had segmental atelectasis due to aspiration. Three of the four patients showed clinical and radiographic improvement within 48 hours of starting IPV. The fourth patient experienced brief episodes of third-degree atrioventricular block, hypoxemia, and bradycardia during two IPV treatments. IPV was safely restarted and he slowly improved. We conclude that while IPV requires further clinical evaluation, it appears to be a safe and effective therapy for selected patients. However, close observation is essential during and after IPV treatments, especially in patients who have difficulty mobilizing or expectorating sputum. Pediatr Pulmonol.

Highly active antiretroviral therapy (HAART) has been shown to induce a major and durable viral load reduction accompanied by a stable CD4 increase. This process may evolve with adverse clinical phenomena, known as the immune... more

Highly active antiretroviral therapy (HAART) has been shown to induce a major and durable viral load reduction accompanied by a stable CD4 increase. This process may evolve with adverse clinical phenomena, known as the immune reconstitution inflammatory syndrome (IRIS). In the HIV population, non-tuberculous mycobacteria are a common cause of IRIS. However, only a few cases of Mycobacterium xenopi associated IRIS have been described. This paper concerns a case of M. xenopi pulmonary infection resulting in self-limited immune reconstitution inflammatory syndrome in an HIV-1 infected patient.

The antitumor efficacy as well as hematologic and pulmonary toxicity of Liblomycin, a new lipophilic analog of bleomycin, was evaluated in BDF1 mice. In comparison to bleomycin which was without any antitumor efficacy against P388... more

The antitumor efficacy as well as hematologic and pulmonary toxicity of Liblomycin, a new lipophilic analog of bleomycin, was evaluated in BDF1 mice. In comparison to bleomycin which was without any antitumor efficacy against P388 leukemia, a dose of 10 mg/kg Liblomycin administered on a daily schedule for 10 consecutive days resulted in a significant increase in animal survival (~ T/C of 190). This therapeutic dose and schedule of drug administration did not produce any evidence of pulmonary histopathologic injury; at a similar dose and schedule bleomycin resulted in greater than 40% consolidation of alveolar lung space. Mouse lung collagen synthesis measured as rate of [3H]hydroxyproline formation was increased almost 4-fold by bleomycin 7 days following a single maximally tolerated i.v. injection (133 mg/kg); in contrast, Liblomycin (60 mg/kg) did not significantly alter the rate of lung collagen synthesis compared to saline injected control animals. Lung function was assessed by whole body plethysmography. Bleomycin produced an increase in breathing rates above control values by day 15 following administration of drug at 10 mg/kg (dl -10). Mice treated with Liblomycin did not exhibit an increased rate of breathing. Liblomycin, in contrast to bleomycin, produced mild and transient leukopenia and thrombocytopenia suggesting that this toxicity will be a limiting one in future clinical trials. The only other toxicity noted in this study was the appearance after repeated intraperitoneal administration of Liblomycin of a hepatic collagenous fibrous capsule. The capsule formation resulted in an abnormal and grossly lobulated liver which was believed to have affected animal survival. Intravenous administration of Liblomycin, however, was not associated with any detectable hepatic injury.

Objectives: The objective of this study was to describe the prevalence of pneumonia-like signs and symptoms in patients admitted from the emergency department (ED) with a diagnosis of community acquired pneumonia (CAP) but subsequently... more

Objectives: The objective of this study was to describe the prevalence of pneumonia-like signs and symptoms in patients admitted from the emergency department (ED) with a diagnosis of community acquired pneumonia (CAP) but subsequently discharged from the hospital with a nonpneumonia diagnosis. Methods: A retrospective, structured, chart review of ED patients with CAP at 3 academic hospitals was performed by trained extractors on all adult patients admitted for CAP. Demographic data, Pneumonia Patient Outcomes Research Team scores, and discharge diagnosis data (International Classification of Diseases, Ninth Revision [ICD-9] codes) were extracted using a predetermined case report form. Results: A total of 800 patients were admitted from the ED with a diagnosis of CAP from the 3 hospitals, and 219 (27.3%; 95% confidence interval [CI], 24-31) ultimately had a nonpneumonia diagnosis upon discharge. Characteristics of this group included a mean age of 62.6 years, 50% female, and a history of congestive heart failure (CHF) (14%) or cancer (12%). After excluding patients with missing data, 123 patients (65%) had an abnormal chest x-ray, and 13% had abnormal oxygen saturation. Cough, sputum production, fever, tachypnea, or leukocytosis were present in 91.5% of this cohort, and 63.8% had at least 2 of these findings. Twenty alternate ICD-9s were identified, including non-CAP pulmonary disease (18%; 95% CI, 13-24), renal disease (16%; 95% CI, 13-19), other infections (9%; 95% CI, 7-11), cardiovascular diseases (3%; 95% CI, 2-4), and other miscellaneous diagnosis (28%; 95% CI, 25-31). Conclusions: Our data suggest that the ED diagnosis of CAP frequently differs from the discharge diagnosis. This may be due to the fact that a diagnosis of CAP relies on a combination of potentially nonspecific clinical and radiographic features. New diagnostic approaches and tools with better specificity are needed to improve ED diagnosis of CAP.

Objective: To determine whether infants with chronic lung disease (CLD), ready for neonatal unit discharge, maintain cardiorespiratory stability while sleeping supine. Methods: Subjects were 15 infants born <32 weeks gestational age (GA)... more

Objective: To determine whether infants with chronic lung disease (CLD), ready for neonatal unit discharge, maintain cardiorespiratory stability while sleeping supine. Methods: Subjects were 15 infants born <32 weeks gestational age (GA) and ready for discharge from the regional tertiary neonatal intensive care unit. Polysomnography recordings of sleep state, heart rate, arterial oxygen saturation, respiratory effort and nasal/oral airflow were taken prone and supine for up to 3 h post feed with the first position randomly allocated. The main outcome measures were oxygen saturation and apnoea hypopnoea index (AHI). Results: Seven infants (median GA 27 weeks, birthweight 945 g) had CLD and eight infants (median GA 29 weeks, birthweight 1160 g) did not. CLD infants were more mature at study than non-CLD infants (median 39 vs 36 weeks, P = 0.019). Neither oxygen saturation nor AHI were position dependent and no group differences were noted with respect to CLD status. There was a significant interaction of GA and sleep position with less-mature infants spending less time in quiet sleep (QS) in supine position (P = 0.006). These less-mature infants also had a higher AHI (P = 0.033). As expected, the AHI and arousal index (AI) were higher in active sleep (P ≤ 0.001, P = 0.013, respectively) and mean oxygen saturation was lower (P = 0.001). Conclusions: The supine position appears appropriate for very preterm infants with CLD going home from the neonatal unit. Respiratory instability on neonatal discharge is more likely to be associated with immaturity than CLD.

The non-neuronal cholinergic system is widely expressed in human airways. Choline acetyltransferase (ChAT) and/or acetylcholine are demonstrated in more or less all epithelial surface cells (goblet cells, ciliated cells, basal cells),... more

The non-neuronal cholinergic system is widely expressed in human airways. Choline acetyltransferase (ChAT) and/or acetylcholine are demonstrated in more or less all epithelial surface cells (goblet cells, ciliated cells, basal cells), submucosal glands and airway smooth muscle fibres. Acetylcholine is also demonstrated in the effector cells of the immune system (lymphocytes, macrophages, mast cells). Epithelial, endothelial and immune cells express nicotinic and muscarinic receptors. Thus the cytomolecule acetylcholine can contribute to the regulation of basic cell functions via auto-/paracrine mechanisms (proliferation, differentiation, ciliary activity, secretion of water, ions and mucus, organization of the cytoskeleton, cell-cell contact). Acetylcholine also modulates immune functions (release of cytokines; proliferation, activation and inhibition of immune cells). Preliminary experimental evidence suggests that mucosal inflammation may be associated with raised acetylcholine le...

Pulmonary diseases are increasingly important causes of morbidity and mortality in the modern world. The COPDs are the most common chronic lung diseases, and are a major cause of lung-related death and disability. [1] Pulmonary... more

Pulmonary diseases are increasingly important causes of morbidity and mortality in the modern world. The COPDs are the most common chronic lung diseases, and are a major cause of lung-related death and disability. [1] Pulmonary rehabilitation has emerged as a ...

Acute respiratory distress BAL Bronchoalveolar lavage BO Bronchiolitis obliterans BOOP Bronchiolitis obliterans organizing pneumonia OLB Open lung biopsy Objectives: To determine the value of open lung biopsy (OLB) in terms of diagnosis,... more

Acute respiratory distress BAL Bronchoalveolar lavage BO Bronchiolitis obliterans BOOP Bronchiolitis obliterans organizing pneumonia OLB Open lung biopsy Objectives: To determine the value of open lung biopsy (OLB) in terms of diagnosis, morbidity, mortality, and benefits in immunocompromised children with pulmonary involvement. Study design: We retrospectively reviewed 36 OLBs performed in 32

Polymyositis (PM) and dermatomyositis (DM) are connective tissue diseases (CTD) characterized by proximal muscle weakness along with changes in various internal organs, with the lungs most frequently involved. Presentation of the disease... more

Polymyositis (PM) and dermatomyositis (DM) are connective tissue diseases (CTD) characterized by proximal muscle weakness along with changes in various internal organs, with the lungs most frequently involved. Presentation of the disease in the lungs comprises diffuse alveolar haemorrhage due to vasculitis and interstitial lung disease (ILD), which is the most frequent manifestation of CTD in the lungs and worsens the outcome and prognosis. The mechanisms involved in the ILD are not fully known, but the role of autoimmune response is unquestioned. No relationship between the severity of CTD and the changes in the lungs was observed. ILD may present at any time in the course of CTD, sometimes before the signs and symptoms of myositis occur. The more accurate imaging methods are, the more frequently changes in the lungs are detected. High resolution computed tomography (HRCT) is a gold standard in ILD imaging. Treatment of PM/DM-related ILD relays on systemic glucocorticosteroids as t...

Five per cent of patients with primary Sjogren's syndrome (pSS) develop malignant non-Hodgkin's lymphoma (NHL), usually of the mucosa-associated lymphoid tissue (MALT) and most frequently located in the major salivary glands. Rituximab... more

Five per cent of patients with primary Sjogren's syndrome (pSS) develop malignant non-Hodgkin's lymphoma (NHL), usually of the mucosa-associated lymphoid tissue (MALT) and most frequently located in the major salivary glands. Rituximab (RTX), a chimeric monoclonal antibody against the CD20 molecule expressed on the surface of mature B cells that has been approved for the treatment of NHL, has been used to treat pSS-associated lymphoma. We have described two cases: one with MALT lymphoma in the parotid glands and the other with a rare thymus lymphoma accompanied by the rare complication of a bullous pneumopathy. Both were treated with RTX at haematological doses, which was unsuccessful in the patient with a salivary lymphoma; in the case of the patient with a thymus lymphoma, the mediastinum mass disappeared and did not relapse. Both patients experienced an improvement in the subjective symptoms of dryness, and their Schirmer's test and scialoscintigraphy results stabilised. The pulmonary bullae remained unchanged.

We performed a multicenter, historical-cohort analysis to identify factors associated with chronic lung disease (CLD) in extremely low birth weight infants. The 235 infants who were born in 1984 with birth weights of 751 to 1000 gm and... more

We performed a multicenter, historical-cohort analysis to identify factors associated with chronic lung disease (CLD) in extremely low birth weight infants. The 235 infants who were born in 1984 with birth weights of 751 to 1000 gm and admitted to any of 10 participating neonatal intensive care units comprised the study population. We analyzed demographic characteristics, status at birth, severity of acute atelectasis, and early respiratory treatment in relation to CLD, which we defined as having received oxygen at age 30 days. By univariate analysis, CLD was associated with lower gestational age (p <:0.001), male sex (p = 0.004), more severe acute atelectasis as indicated by a higher roentgenographic score (p <:0.001), a higher ventilation rate at 96 hours (p = 0.012), and lower Paco2 at 48 hours (p = 0.04). Infants receiving mechanical ventilation whose highest Paco2 levels at 48 or 96 hour were <:40 mm Hg were 1.45 times as likely to develop CLD as those whose highest Paco2 levels were >50 mm Hg (95% confidence interval 1.04 to 2.01). CLD rates by center were inversely related to mean Paco2 levels in infants receiving mechanical ventilation at 48 and 96 hours (Spearman rank correlations 0.60 and 0.55; p <:0.001). A logistic risk model that included sex, Paco= at 48 hours, roentgenographic score, gestational age, and race showed only male sex (p = 0.009) and lower Paco2 at 48 hours (p = 0.04) to be independent predictors of CLD. We conclude that mechanical ventilation that results in Paco2 levels above the physiologic range may decrease the risk of CLD in extremely low birth weight infants. (J PEDIATR 1989;115:115-20) Recent studies have shown that the incidence of chronic lung disease in premature infants at 28 days varies among newborn intensive care units even after controlling for birth weight, race, and sex. 1,2 In a survey in North Carolina, after controlling for birth weight, we found differences among 10 NICUs in the incidence of CLD in very low birth weight infants at 30 days? The incidence of CLD was not related to mortality rates before 30 days, the number of VLBW infants treated, or whether treatment was given by pediatric residents.

Introduction: To study the role of CT scan chest and fiber optic bronchoscopy in evaluating patients with hemoptysis and normal chest radiograph. Materials and Method: 50 patients over the age of 15 years having hemoptysis with normal... more

Introduction: To study the role of CT scan chest and fiber optic bronchoscopy in evaluating patients with hemoptysis and normal chest radiograph. Materials and Method: 50 patients over the age of 15 years having hemoptysis with normal chest X ray in a government teaching hospital in Andhra Pradesh were taken as study subjects. They were evaluated using FOB and CT thorax. Other investigations were done when necessary. Results: The mean age of the study population was 44.5 ± 13.5 years with age ranging from 20yrs to 80yrs. Of them 28(56%) were males and 22 (44%) females. Out of 50 such patients, a definitive diagnosis could be established in 33 patients (66%) with commonest being tuberculosis (12/50, 24%), followed by acute bronchitis (11/50, 22%), bronchiectasis (7/50, 14%), aspergilloma (2/50, 4%), malignancy (1/50,2%). CT scan is more efficacious in establishing a diagnosis of bronchiectasis than bronchoscopy (P < 0.05) while bronchoscopy is more sensitive in making a diagnosis of bronchitis than CT scan (P < 0.05). There was no statistically significant difference between CT scan and bronchoscopy (P > 0.05) in diagnosing PTB in patients with hemoptysis and normal CXR. CT scan solely diagnosed 30% cases with bronchoscopic findings being normal. While FOB solely diagnosed 28% cases with CT features being normal. In 8% cases both modalities established the diagnosis. Conclusions: Overall, there was no statistically significant difference (P > 0.05) between CT scan and bronchoscopy in diagnosing the underlying cause of hemoptysis. Therefore, CT scan and bronchoscopy are equally important and complementary to each other in establishing diagnosis in a patient with hemoptysis and normal chest radiograph.

Chlorine (Cl(2)) is a reactive oxidant gas used extensively in industrial processes. Exposure of both humans and animals to high concentrations of Cl(2) results in acute lung injury, which may resolve spontaneously or progress to acute... more

Chlorine (Cl(2)) is a reactive oxidant gas used extensively in industrial processes. Exposure of both humans and animals to high concentrations of Cl(2) results in acute lung injury, which may resolve spontaneously or progress to acute respiratory failure. Injury to airway and alveolar epithelium may result from chemical reactions of Cl(2), from HOCl (the hydrolysis product of Cl(2)), and/or from the various reaction products, such as chloramines, that are formed from the reactions of these chlorinating species with biological molecules. Subsequent reactions may initiate self-propagating reactions and induce the production of inflammatory mediators compounding injury to pulmonary surfactant, ion channels, and components of lung epithelial and airway cells. Low-molecular-weight antioxidants, such as ascorbate, glutathione, and urate, present in the lung epithelial lining fluid and tissue, remove Cl(2) and HOCl and thus decrease injury to critical target biological targets. However, l...

This article offers the opportunity to earn one Category 1 credit toward the AMA Physician's Recognition Award.

The mildew of the vineyards is prevented by the use of sprays with a solution of copper sulphate neutralized with hydrated lime. The inhalation of this solution while spraying may give rise to predominantly interstitial pulmonary lesions... more

The mildew of the vineyards is prevented by the use of sprays with a solution of copper sulphate neutralized with hydrated lime. The inhalation of this solution while spraying may give rise to predominantly interstitial pulmonary lesions which may lead to respiratory insufficiency. These lesions, which were experimentally reproduced in guinea-pigs, have a well-defined histological picture characterized by three stages-intra-alveolar desquamation of macrophages, formation of predominantly histiocytic granulomas in the septa, and the healing of these lesions generally under the form of fibro-hyaline nodules very similar to those found in silicosis. These lesions contain variable amounts of copper. The pathogenesis of these lesions and the possibility of their regression when the offending agent is removed are discussed; and the value of lung biopsy and the necessity of protecting these workers are stressed.

Examination of lung lesions at the slaughterhouse is a useful tool to estimate the importance of respiratory disease at farm, regional or national level. The objective of the present work was to describe the prevalence of gross lung... more

Examination of lung lesions at the slaughterhouse is a useful tool to estimate the importance of respiratory disease at farm, regional or national level. The objective of the present work was to describe the prevalence of gross lung lesions at slaughter, with a special focus on pleuritis and cranio-ventral pulmonary consolidation, and to identify major risk factors for these lesions. Data from 107 farms involving approximately 11,000 pigs enabled gross lung lesions to be correlated with serology to different swine respiratory pathogens as well as with production system characteristics and vaccination schedules.

To investigate the criterion or concurrent validity of the Northwick Park Dependency Score (NPDS) for determining nursing dependence in different rehabilitation groups, with the Barthel Index (BI) and the Care Dependency Scale (CDS).... more

To investigate the criterion or concurrent validity of the Northwick Park Dependency Score (NPDS) for determining nursing dependence in different rehabilitation groups, with the Barthel Index (BI) and the Care Dependency Scale (CDS). Cross-sectional study. Centre for Rehabilitation of the University Medical Center Groningen, The Netherlands. Patients after stroke, spinal cord injury, multitrauma, head injury, amputation, rheumatoid arthritis, diabetes mellitus, lung diseases, tuberculosis and coronary artery disease. One hundred and fifty-four patients were included. The Northwick Park Dependency Score (NPDS), the Barthel Index (BI) and the Care Dependency Scale (CDS). The correlation (rho) between the NPDS and the BI for all groups was -0.87; R2=0.76 (n=154). Per patient group rho varied from -0.70 (R2=0.49) to -0.93 (R2=0.86). The overall correlation between the NPDS and CDS was larger than the criterion of rho=0.60 (r=-0.74; R2=0.55) but was <0.60 in the rheumatoid arthritis a...

Until the mid 1970s, it was generally assumed that, with the short pulses of ultrasound (US) used in medical diagnosis, there was little need for concern about the possibility of inertial cavitation in vivo. This assumption came into... more

Until the mid 1970s, it was generally assumed that, with the short pulses of ultrasound (US) used in medical diagnosis, there was little need for concern about the possibility of inertial cavitation in vivo. This assumption came into question when experimental evidence indicated that killing of fruit fly larvae by diagnostically relevant US was associated with the presence of gas in the respiratory apparatus of the organisms. Independent theoretical contributions by Flynn and Apfel in the early 1980s made it clear that complacency in regard to cavitation was not warranted. Later, the mammalian lung, as with larva, was shown to be particularly vulnerable when it contained air. Yet, overall evidence suggests that lung hemorrhage is not consistent with the classical picture of inertial cavitation. Most recently, however, hemolysis and hemorrhage associated with the use of contrast agents have provided nearly incontrovertible evidence of the occurrence of cavitation in vivo.

Purpose: Recently the emphasis has been laid upon the carbohydrate mediated liposomal interactions with the target cells. Among the various carbohydrate ligands, such as glycoproteins, glycolipids, viral proteins, polysaccharides,... more

Purpose: Recently the emphasis has been laid upon the carbohydrate mediated liposomal interactions with the target cells. Among the various carbohydrate ligands, such as glycoproteins, glycolipids, viral proteins, polysaccharides, lipo-polysaccharides and other oligosaccharides, this review deals with the polysaccharide anchored liposomal system for their potential in drug delivery, targeting and immunization. Over the years, various strategies have been developed which include coating of the liposomal surface with natural or hydrophobized polysaccharides, namely mannan, pullulan, amylopectin, dextran etc., or their palmitoyl or cholesteroyl derivatives. The polysaccharide(s) coat tends vesicular constructs physicochemically stable in bio-environments and site-specific. The aim of improving the physical and biochemical stability of liposomes and the ability to target liposomes to specific organs and cells, were the major attributes of the polysaccharide anchored liposomes. In this review the authors attempted to overview various applications of polysaccharide bearing liposomes, including lung therapeutics, targeted chemotherapy, cellular targeting, cellular or mucosal immunity and macrophage activation. Future prospects of the delivery module are also discussed. The review in general explores the concepts, options and opportunities of polysaccharide anchored liposomes with newer perspectives.

Background. The objective of this study was to better characterize prolonged air leak (PAL), defined as an air leak longer than 7 days, and to develop and validate a predictive model of this complication after pulmonary resection.

Birt-Hogg-Dubé syndrome (BHD) is an autosomal dominant condition characterised clinically by skin fi brofolliculomas, pulmonary cysts, spontaneous pneumothorax, and renal cancer. The condition is caused by germline mutations in the FLCN... more

Birt-Hogg-Dubé syndrome (BHD) is an autosomal dominant condition characterised clinically by skin fi brofolliculomas, pulmonary cysts, spontaneous pneumothorax, and renal cancer. The condition is caused by germline mutations in the FLCN gene, which encodes folliculin; the function of this protein is largely unknown, although FLCN has been linked to the mTOR pathway. The availability of DNA-based diagnosis has allowed insight into the great variation in expression of FLCN, both within and between families. Patients can present with skin signs and also with pneumothorax or renal cancer. Preventive measures are aimed mainly at early diagnosis and treatment of renal cancer. This Review gives an overview of current diagnosis and management of BHD.

Chest ultrasonography is a useful tool for assessing disease activity in the peripheral lung parenchyma, pleura, chest wall, diaphragm, and mediastinum. Ultrasound imaging also provides highly useful guidance in invasive diagnostic and... more

Chest ultrasonography is a useful tool for assessing disease activity in the peripheral lung parenchyma, pleura, chest wall, diaphragm, and mediastinum. Ultrasound imaging also provides highly useful guidance in invasive diagnostic and therapeutic procedures. The main advantages of this imaging technology are the absence of ionizing radiation and the possibility of real-time bedside applications. The chief indications and limitations of chest ultrasonography and the principal sonographic signs are reviewed.

Intratracheal (i.t.) or intravenous (i.v.) administration of FR90145 1, a potent inhibitor of human leukocyte elastase (HLE) prevented HLE-induced lung hemorrhage in hamsters with ED50 values of 10.5 /ig/site and 8. 1 mg/kg, respectively.... more

Intratracheal (i.t.) or intravenous (i.v.) administration of FR90145 1, a potent inhibitor of human leukocyte elastase (HLE) prevented HLE-induced lung hemorrhage in hamsters with ED50 values of 10.5 /ig/site and 8. 1 mg/kg, respectively. al-Antitrypsin (al-AT) also showed inhibitory effect in this model. However, the ED50 value by i.t. injection of FR901451was 20-fold lower than that of al-AT. Moreover, FR901451 i.t. significantly modulated porcine pancreas elastase (PPE)-induced changes of the respiratory mechanics in hamsters. The ED50 values were 529 /zg/site and 244 //g/site, which were expressed by static lung compliance (Cst) and vital capacity (VC) of the lungs, respectively. These results suggest that FR90145 1 could be clinically useful agent for the treatment of the destructive lung disease such as pulmonary emphysema.

Background and objective: Laceration of the intercostal artery during pleural procedures is a rare but serious complication. This study evaluates the utility of thoracic ultrasound (US) to screen for a vulnerable vessel compared with the... more

Background and objective: Laceration of the intercostal artery during pleural procedures is a rare but serious complication. This study evaluates the utility of thoracic ultrasound (US) to screen for a vulnerable vessel compared with the gold standard computed tomography (CT). Methods: Before undergoing contrast-enhanced CT chest, thoracic US was performed on 50 patients with a high-end and portable machine, and an attempt made to visualize the vessel at three positions across the back to the axilla. These positions were labelled with radioopaque fiducial markers. On both US and CT images, the location of the vessel at each position, relative to the overlying rib, was calculated and compared. Results: The vessel was unshielded by a rib according to CT in 114 of the 133 positions. The sensitivity, specificity and negative predictive value of portable US to image the vessel, when it was within the intercostal space on CT, was 0.86, 0.30 and 0.27 respectively. The performance of a high-end machine was not significantly different.The median time required for a pulmonologist to locate the vessel was 42 s and 18 s for the portable and high-end US respectively. Conclusions: US can be used to screen for a vulnerable vessel prior to pleural procedures, in a time amenable to use in clinical practice. Further, it is achievable by a pulmonologist using a portable US machine. If thoracentesis or chest tube insertion is being performed on a patient at increased risk of bleeding, screening for a vulnerable vessel with US prior to beginning the procedure is recommended. This paper examines the ability of US to image the intercostal artery, using CT angiography as a gold standard comparator, and demonstrates that a physician can reliably identify a vulnerable intercostal artery using thoracic US, prior to chest drainage procedures. bs_bs_banner

The incidence and severity of exercise-induced pulmonary haemorrhage (EIPH) in the 2 most commonly raced horse breeds, Thoroughbreds (TB) and Standardbreds (STD), were studied, with particular interest in the possible influence of... more

The incidence and severity of exercise-induced pulmonary haemorrhage (EIPH) in the 2 most commonly raced horse breeds, Thoroughbreds (TB) and Standardbreds (STD), were studied, with particular interest in the possible influence of frusemide (F) and/or the breed (or running gait) on EIPH. The appearance of blood within the trachea was semi-quantified using a published 5-point system, with zero assigned when no blood was observed, and numbers 1-4 assigned with increasing amounts of blood. Considering each endoscopic examination as a separate event, approximately 75% of the postrace endoscopic examinations had blood-scores of 1, 2, 3, or 4, regardless of breed or F administration. For horses examined twice, the chances of finding blood-scores of 1 or greater in either of the examinations increased to approximately 95%. All horses examined 3 or more times had endoscopic blood-scores of 1 or greater following one or more races, again, irrespective of the breed or F administration. Mean ± s.e. 'blood scores' were 1.5 ± 0.1 and 1.8 ± 0.2 for TB, and 1.4 ± 0.2 and 1.2 ± 0.1 for STD racing with and without prerace F, respectively. Therefore, there was no apparent effect of breed (or possibly racing gait) on EIPH, and no differences in the incidence or severity of EIPH were observed between horses with or without prerace frusemide administration.

The aim of the subcommittee was to identify a core set of feasible variables reflecting the occurrence of interstitial and/or vascular lung disease. After extensive review of published studies and critical assessment of candidate... more

The aim of the subcommittee was to identify a core set of feasible variables reflecting the occurrence of interstitial and/or vascular lung disease. After extensive review of published studies and critical assessment of candidate variables, the subcommittee identified the minimal requirements to assess lung disease. Two core sets of variables are provided: the first concerns interstitial lung disease; the second pulmonary vascular disease.

Thoracopulmonary actinomycosis can mimic various lung pathologies such as bronchogenic carcinoma, tuberculosis and fungal pneumonia, to name but a few. The common causative agent is Actinomyces israelii. The disease is successfully... more

Thoracopulmonary actinomycosis can mimic various lung pathologies such as bronchogenic carcinoma, tuberculosis and fungal pneumonia, to name but a few. The common causative agent is Actinomyces israelii. The disease is successfully diagnosed only if there is a high index of suspicion and a thorough evaluation with multidisciplinary involvement. We present a case of thoracopulmonary actinomycosis in a young immunocompetent man who did not have any predisposing illness, and who was treated initially for pulmonary tuberculosis. He showed good response to injection crystalline penicillin, which was later changed to oral amoxicillin.