Current Issue : October - December Volume : 2012 Issue Number : 4 Articles : 7 Articles
Background: Patients with chronic asthma have thicker intrapulmonary airways measured on high resolution\r\ncomputed tomography (HRCT). We determined whether the presence of lower airway bacteria was associated with\r\nincreased airway wall thickness.\r\nMethods: In 56 patients with stable severe asthma, sputum specimens obtained either spontaneously or after\r\ninduction with hypertonic saline were cultured for bacteria and thoracic HRCT scans obtained. Wall thickness (WT)\r\nand area (WA) expressed as a ratio of airway diameter (D) and total area, respectively, were measured at five levels.\r\nResults: Positive bacterial cultures were obtained in 29 patients, with H. influenzae, P. aeruginosa and S. aureus\r\nbeing the commonest strains. Logistic regression analysis showed that this was associated with the duration of\r\nasthma and the exacerbations during the past year. In airways > 2 mm, there was no significant difference in WA\r\n(67.5 �± 5.4 vs 66.4 �± 5.4) and WT/D (21.6 �± 2.7 vs 21.3 �± 2.4) between the culture negative versus positive groups.\r\nSimilarly, in airways (= 2 mm), there were no significant differences in these parameters. The ratio of vwall area to\r\nPi was negatively correlated with FEV1% predicted (p < 0.05).\r\nConclusions: Bacterial colonization of the lower airways is common in patients with chronic severe asthma and is\r\nlinked to the duration of asthma and having had exacerbations in the past year, but not with an increase in airway\r\nwall thickness....
Background: Acute respiratory disorders may lead to sustained alveolar hypoxia with hypercapnia resulting in\r\nimpaired pulmonary gas exchange. Hypoxic pulmonary vasoconstriction (HPV) optimizes gas exchange during local\r\nacute (0-30 min), as well as sustained (> 30 min) hypoxia by matching blood perfusion to alveolar ventilation.\r\nHypercapnia with acidosis improves pulmonary gas exchange in repetitive conditions of acute hypoxia by\r\npotentiating HPV and preventing pulmonary endothelial dysfunction. This study investigated, if the beneficial\r\neffects of hypercapnia with acidosis are preserved during sustained hypoxia as it occurs, e.g in permissive\r\nhypercapnic ventilation in intensive care units. Furthermore, the effects of NO synthase inhibitors under such\r\nconditions were examined.\r\nMethod: We employed isolated perfused and ventilated rabbit lungs to determine the influence of hypercapnia\r\nwith or without acidosis (pH corrected with sodium bicarbonate), and inhibitors of endothelial as well as inducible\r\nNO synthase on acute or sustained HPV (180 min) and endothelial permeability.\r\nResults: In hypercapnic acidosis, HPV was intensified in sustained hypoxia, in contrast to hypercapnia without\r\nacidosis when HPV was amplified during both phases. L-NG-Nitroarginine (L-NNA), a non-selective NO synthase\r\ninhibitor, enhanced acute as well as sustained HPV under all conditions, however, the amplification of sustained\r\nHPV induced by hypercapnia with or without acidosis compared to normocapnia disappeared. In contrast 1400 W,\r\na selective inhibitor of inducible NO synthase (iNOS), decreased HPV in normocapnia and hypercapnia without\r\nacidosis at late time points of sustained HPV and selectively reversed the amplification of sustained HPV during\r\nhypercapnia without acidosis. Hypoxic hypercapnia without acidosis increased capillary filtration coefficient (Kfc).\r\nThis increase disappeared after administration of 1400 W.\r\nConclusion: Hypercapnia with and without acidosis increased HPV during conditions of sustained hypoxia. The\r\nincrease of sustained HPV and endothelial permeability in hypoxic hypercapnia without acidosis was iNOS\r\ndependent....
Epidermodysplasia verruciformis (EV) is a rare autosomal recessive hereditary disease, characterized by defects in cell-mediated immunity, susceptibility to skin infections by Human Papillomavirus (HPV) and development of multiple cutaneous sqamouas cell carcinoma. While the oncogenic role of HPV is well recognized, only cutaneous sqamouas cell carcinoma was associated with EV. Herein we report of a patient with EV in whom lung cancer developed at a very young age, raising the possibility that HPV had a causative effect. A 21-year-old man with EV and squamous cell carcinoma of the left lower eyelid was referred to the oncology clinic. One year later, the patient complained of right chest pain. Computer tomography revealed lung mass and a bone lesion. Bone biopsy confirmed the diagnosis of poorly differentiated squamous cell carcinoma of the lung. The cytological features were clearly distinctive from those in the skin. The present case suggests possible association between EV and squamous cell carcinoma of the lung. This observation may contribute to the understanding of the pathogenesis of these conditions....
To determine the prevalence of lung involvement and the spectrum of abnormalities revealed on HRCT in patients with AS, a\r\nsystematic literature review was conducted in theMedline database up toMay 2009 and in the abstracts of rheumatology scientific\r\nmeetings (2006ââ?¬â??2008). A hand search of references was also performed. Among the 264 selected articles, 10 articles (303 patients)\r\nallowed a calculation of the prevalence of lung abnormalities on thoracic HRCT in AS. A total of 185 patients (61%) had an\r\nabnormal thoracic HRCT: upper lobe fibrosis in 21 (6.9%), emphysema in 55 (18.1%), bronchiectasis in 33 (10.8%), and ground\r\nglass attenuation in 34 (11.2%). Non specific interstitial abnormalities were observed in 101 (33%) patients. The most common\r\nobserved abnormalities were pleural thickening (52%), parenchymal bands (45%) and interlobular septal thickening (30%). Only\r\nthe prevalence of upper lobe fibrosis increased significantly with disease duration (3 studies). Mild and non-specific interstitial\r\nabnormalities on thoracic HRCT are common in patients with AS, even in patients with early disease and without respiratory\r\nsymptoms....
Pulmonary Alveolar Proteinosis (PAP) is a rare syndrome characterized by pulmonary surfactant accumulation within\r\nthe alveolar spaces. It occurs with a reported prevalence of 0.1 per 100,000 individuals and in distinct clinical forms:\r\nautoimmune (previously referred to as the idiopathic form, represents the vast majority of PAP cases, and is\r\nassociated with Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) auto-antibodies; GMAbs), secondary\r\n(is a consequence of underlying disorders), congenital (caused by mutations in the genes encoding for the GM-CSF\r\nreceptor), and PAP-like syndromes (disorders associated with surfactant gene mutations). The clinical course of PAP\r\nis variable, ranging from spontaneous remission to respiratory failure. Whole lung lavage (WLL) is the current\r\nstandard treatment for PAP patients and although it is effective in the majority of cases, disease persistence is not\r\nan unusual outcome, even if disease is well controlled by WLL.\r\nIn this paper we review the therapeutic strategies which have been proposed for the treatment of PAP patients and\r\nthe progress which has been made in the understanding of the disease pathogenesis...
Pulmonary Langerhans� Cell Histiocytosis (PLCH) is a rare interstitial lung disease with characteristic radiological\r\nfeatures on high resolution computed tomography (HRCT). The diagnosis is usually delayed as the illness is either\r\nasymptomatic or has mild symptoms in the initial stage. We present a case of 54 yrs old smoker who presented\r\nwith acute febrile illness associated with cough and sputum production due to upper respiratory tract infection. A\r\nsubtle abnormality on chest X-ray led to the performance of HRCT chest showing few tiny nodules which progressed\r\non repeat HRCT after a period of observation. A thoracoscopic lung biopsy confirmed the diagnosis of Pulmonary\r\nLangerhans� Cell Histiocytosis (PLCH). This case represents an earliest radiological stage of PLCH....
Background: The obese-asthma phenotype is not well defined. The aim of this study was to examine both\r\nmechanical and inflammatory influences, by comparing lung function with body composition and airway\r\ninflammation in overweight and obese asthma.\r\nMethods: Overweight and obese (BMI 28-40 kg/m2) adults with asthma (n = 44) completed lung function\r\nassessment and underwent full-body dual energy x-ray absorptiometry. Venous blood samples and induced\r\nsputum were analysed for inflammatory markers.\r\nResults: In females, android and thoracic fat tissue and total body lean tissue were inversely correlated with\r\nexpiratory reserve volume (ERV). Conversely in males, fat tissue was not correlated with lung function, however\r\nthere was a positive association between android and thoracic lean tissue and ERV. Lower body (gynoid and leg)\r\nlean tissue was positively associated with sputum %neutrophils in females, while leptin was positively associated\r\nwith android and thoracic fat tissue in males.\r\nConclusions: This study suggests that both body composition and inflammation independently affect lung\r\nfunction, with distinct differences between males and females. Lean tissue exacerbates the obese-asthma\r\nphenotype in females and the mechanism responsible for this finding warrants further investigation...
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