摘要:

Two hundred and four patients with pleural effusion were studied to investigate the utility of Light’s criteria and pleural fluid cholesterol level (pCHOL) in the identification of exudative pleural effusion (EPE) and transudative pleural effusion (TPE). There were 48 TPE, 56 tumor, 47 tuberculous, 30 metapneumonic and 23 miscellaneous patients. A value ≧ 54 mg/dl for pCHOL and > 0.32 for the pleura/serum cholesterol ratio (p/sCHOL) showed sensitivity (S) and specificity (Sp) of 95.5% and 91.6% for pCHOL, and 97.4% and 91.6% for p/sCHOL, respectively. Combined pCHOL and/or p/sCHOL showed a S of 98.7% and Sp of 89.5%. Light’s criteria achieved a S of 100% and Sp of 64.5%. Combined pCHOL and p/sCHOL revealed a similar accuracy to Light’s criteria in EPE diagnosis but was found to be more exact in TPE di

ISSN:0025-7931    

DOI:10.1159/000196392

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Pulmonary surfactant protein A (SP-A) is known to be a major phospholipid-associated glycoprotein in pulmonary surfactant, which is specific to the lung. In this study, the SP-A concentrations in sera of patients with various lung diseases were determined using an enzyme-linked immunosorbent assay. Patients with idiopathic pulmonary fibrosis (IPF) and pulmonary alveolar proteinosis (PAP) exhibited prominently high concentrations of serum SP-A compared to those of other lung diseases and healthy volunteers, although there were significant increases in serum SP-A concentrations in patients with pulmonary tuberculosis, chronic pulmonary emphysema, diffuse panbronchiolitis and bacterial pneumonia compared to those of healthy volunteers. Successive measurement in 2 patients with IPF showed that serum SP-A levels reflect the disease activity of IPF. In patients with IPF, serum SP-A concentrations were significantly correlated with those of serum lactate dehydrogenase, whereas there were no significant correlations of serum SP-A concentrations with erythrocyte sedimentation rate, arterial oxygen saturation, vital capacity and carbon monoxide diffusing capacity. Determination of serum SP-A will contribute to diagnosing IPF and PAP, and may reflect the disease activity of IPF.

ISSN:0025-7931    

DOI:10.1159/000196393

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The hypercapnic ventilation response (HCVR) is positively correlated with forced expired volume in 1 s (FEV1). Therefore, subjects of small stature or patients with lung disease have low values for HCVR. However, indexing the HCVR for the subject’s predicted maximal voluntary ventilation (MW) results in a corrected HCVR (CHCVR) which is not dependent on FEV1 in normal subjects [Respiration 1993;60:197-202]. We hypothesized that the CHCVR would also be useful in assessing chemosensitivity in patients with poor lung function. To obtain the predicted MW, we used the linear regression for FEV1 vs. measured MW obtained from 411 patients with a wide range of FEV1 values (MW = 31.2 × FEV1 + 11.8, r = 0.90, p < 0.001). We compared HCVR and CHCVR to the occlusion pressure response to hypercapnia (OPRH) in 34 patients with chronic obstructive pulmonary disease (COPD) and in 19 patients with low FEV1 due to small stature. All patients had been referred for assessment of possible sleep apnea. The results for the two groups of patients were similar. For the COPD patients, the HCVR had high values for sensitivity (86%) and negative predictive value (94%), but specificity, positive predictive value and accuracy were low (59, 35 and 65%, respectively). In contrast, CHCVR had high values for all the foregoing (86, 96, 100, 100 and 97%, respectively). Our results suggest that the CHCVR is useful in assessing chemosensitivity in patients who are ventilation-limit

ISSN:0025-7931    

DOI:10.1159/000196394

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

It is hypothesized that emphysema develops in some severely α1-antitrypsin (AAT)-deficient persons because endogenous elastases are not adequately controlled by AAT, and accelerated elastin degradation occurs. It is not known whether augmentation therapy with AAT diminishes degradation of lung elastin in severely deficient persons with lung disease. Two severely deficient, PiZ patients were studied, a 63-year-old never-smoking woman with bronchiectasis and a 41-year-old smoking man with emphysema. Urinary desmosine (DES) was determined before and after augmentation therapy with AAT, 260 mg/kg/month. Mean ± SEM pretreatment urinary DES was elevated in both patients, 19.7 ± 0.9 (n = 2) and 10.8 ± 0.2 (n = 2) μg/g creatinine, respectively, compared to normal values of 7.5 ± 0.3 (n = 22) μg/g creatinine. Following augmentation therapy, urinary DES values decreased 40 and 36%, respectively, to 11.9 ± 0.3 (n = 8) and 6.9 ± 0.4 (n = 7) μg/g creatinine (p < 0.05). We conclude that monthly AAT augmentation therapy decreased DES excretion in the urine of these PiZ patients. We speculate that since there was lung disease in both patients, a decrease in degradation of lung elastin is the most likely explanation for this ob

ISSN:0025-7931    

DOI:10.1159/000196395

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The pattern of pulmonary infections in 59 consecutive bone marrow transplantations in Hong Kong was reviewed. Compared with published data from other marrow transplant units, we had a lower incidence of cytomegalovims pneumonitis (1.7%) and a higher incidence of mycobacterial infections (5%). The latter is probably related to the high background prevalence of tuberculosis in the local population. Treatment with antituberculous drugs was effective.

ISSN:0025-7931    

DOI:10.1159/000196396

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We investigated phenotypic surface markers of peripheral blood lymphocytes including expression of γδ T cell receptor (TCRγδ) in 185 patients with sarcoidosis and 42 normal subjects. The proportion of TCRγδ+ lymphocytes in peripheral blood of patients with sarcoidosis (5.5 ± 5.4%) was significantly higher than in normal subjects (3.6 ± 2.2%; p < 0.05). A number of patients with sarcoidosis had prominently increased levels of circulating TCRγδ+ lymphocytes. Successive measurements of circulating TCRγδ+ lymphocytes demonstrated the persistence of increased levels of circulating TCRγδ + lymphocytes. We divided the patients with sarcoidosis into two groups, one with high, the other with low TCRγδ + expression. Compared with the low-value group, the high-value group had significantly decreased levels of circulating CD4+ lymphocytes, decreased incidence of a positive tuberculin reaction, and higher levels of serum angiotensin-converting enzyme and lysozyme, suggesting that these two groups may differ in their immunological response and disease activity of sarcoidosis. Measurement of TCRγδ+ expression in the circulation seems to be useful for estimating the disease activi

ISSN:0025-7931    

DOI:10.1159/000196397

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

1α,25-Dihydroxyvitamin D3 [1α,25(OH)2D3, calcitriol] has been shown to modulate the immune function of peripheral monocytes and peritoneal macrophages. However, its effect on alveolar macrophage (AM) cytokine secretion has not been reported. We therefore investigated the influence of calcitriol on tumor necrosis factor (TNF-α) production by murine AMs and attempted to elucidate changes in the signal transduction system involved in such effects. Calcitriol significantly enhanced TNF-α secretion by AM stimulated with either lipopolysaccharide (LPS; 10 µg/ml; p < 0.005) or phorbol 12-myristate 13-acetate (PMA; 100ng/ml; p < 0.05) at low doses (between 10-11 and 10-9M). However the protein kinase C (PKC) inhibitor, H7 (10 µM), and the Ca2+/calmodulin inhibitor, W7 (25 µM), reversed such calcitriol effects. Calcitriol increased the total PKC activity of AMs. These findings indicate that calcitriol enhances both LPS- and PMA-stimulated TNF-α secretion through PKC- or Ca2+/calmodulin-dependent p

ISSN:0025-7931    

DOI:10.1159/000196398

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

This study investigated whether or not a sustained release formulation of theophylline (SRT) at different dosages had any effect on bronchial hyperresponsiveness as measured by the methacholine challenge. On four separate occasions, 16 patients with mild asthma took either placebo or 300,400, 500 mg of SRT twice a day. SRT had a slight bronchodilating effect that was not dose-related, but produced a dose-related decrease in the bronchial response to inhaled methacholine (r = 0.39, p = 0.007). This effect was present after all three treatment periods with the active drug when mean ± SE theophylline serum concentrations of 10.3 ± 0.7, 12.6 ± 0.9 and 17.1 ± 1.1 mg/l respectively were reached. A highly significant relationship between theophylline serum concentration and the degree of protection against methacholine bronchospasm was also found (r = 0.45, p = 0.001). It is concluded that oral theophylline does reduce bronchial hyperresponsiveness in a dose dependent fashion, this effect being present at all the serum concentrations within the normal ra

ISSN:0025-7931    

DOI:10.1159/000196399

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

A case of recovery from acute respiratory insufficiency due to paraquat is described. A 57-year-old farmer developed breathlessness, high fever and interstitial infiltrates in the upper and middle lung fields few days after percutaneous paraquat poisoning with rapid evolution to pulmonary fibrosis. Anti-inflammatory drugs and antioxidants, were administered to the patient, though with a delay, with some improvement; the patient survived despite residual lung fibrosis. Paraquat lung, as confirmed by this paper, is not invariably fatal.

ISSN:0025-7931    

DOI:10.1159/000196400

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Neurofibromatosis can involve the mediastinum. A 44-year-old woman with a dumbbell-shaped mediastinal mass developed a large pleural effusion, respiratory failure and fatal hemoptysis. Autopsy revealed systemic neurofibromatosis inolving the mediastinum and pleura. Mediastinal and pleural hemorrhage probably occurred as a result of an eroded thoracic artery. Massive hemorrhage in mediastinal neurofibromatosis occurs uncommonly but with potentially fatal results.

ISSN:0025-7931    

DOI:10.1159/000196401

出版商:S. Karger AG    

年代:1995

数据来源: Karger