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There is still controversy about the feasibility and long-term outcome of surgical treatment of acquired diaphragm paralysis. We analyzed the long-term effects on pulmonary function and level of dyspnea after unilateral or bilateral diaphragm plication.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 4, Issue 3 September 2007 , pages 205 - 216
Exercise training has been shown to be a clinically effective therapeutic intervention for COPD patients resulting in a myriad of beneficial effects. These include improvements in exercise tolerance, health-related quality of life and activity levels. Activity levels can be assessed using health-related quality of life instruments or instruments designed especially for this purpose.
In vitro models of the alveolo-pulmonary barrier consist of microvascular endothelial cells and alveolar epithelial cells cultured on opposing sides of synthetic porous membranes. However, these simple models do not reflect the physiological microenvironment of pulmonary cells, wherein cells are exposed to a complex milieu of mechanical and soluble stimuli.
Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with a cellular inflammatory response. CD8+ T cells are implicated in COPD pathogenesis, and their numbers significantly correlate with the degree of airflow limitation. Dendritic cells (DCs) are important sentinel immune cells, but little is known about their role in initiating and maintaining the CD8 T-cell response in COPD.
Medical Hypothesis Volume 69, Issue 4, Pages 731-740 (2007)
Inflammation and the genes, molecules, and biological pathways that lead to inflammatory processes influence many important and disparate biological processes and disease states that are quite often not generally considered classical inflammatory or autoimmune disorders. These include development, reproduction, aging, tumor development and tumor rejection, cardiovascular pathologies, metabolic disorders, as well as neurological and psychiatric disorders. This paper compares parallel aspects of autism and inflammatory disorders with an emphasis on asthma. These comparisons include epidemiological, morphometric, molecular, and genetic aspects of both disease types, contributing to a hypothesis of autism in the context of the immune based hygiene hypothesis. This hypothesis is meant to address the apparent rise in the prevalence of autism in the population.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 4, Issue 3 September 2007 , pages 257 - 261
Patients with chronic obstructive pulmonary disease (COPD) frequently describe limitations in functional performance. These limitations predict mortality, adversely affect health-care burden and impair health-related quality of life. The optimal method for quantifying the functional performance in COPD subjects has not been established. This paper discusses the (i) nature of limited functional performance reported by individuals with COPD, (ii) mechanisms that contribute to these limitations, (iii) assessment techniques available to provide markers of functional performance and (iv) areas for further research in measuring functional performance of COPD subjects.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 4, Issue 3 September 2007 , pages 283 - 287
Numerous studies demonstrate the importance of exercise training to improve endurance in patients with chronic obstructive pulmonary disease (COPD) and its positive effect on activities of daily living and quality of life. However, successful care of the individual with COPD also relies on recognizing that this person requires individualized care and non-pharmacologic modalities specific to their needs in order to cope with the various aspects of their disease. It is also important to note that improvement in quality of life is not necessarily related to improvement in exercise endurance alone. Comprehensive and effective pulmonary rehabilitation for the COPD patient needs to encompass several components to provide benefit for the spectrum of symptoms of COPD beyond exercise tolerance and dyspnea to ultimately improve quality of life.
COPD Journal of Chronic Obstructive Pulmonary Disease, Volume 4, Issue 3 September 2007 , pages 225 - 236
Dyspnea and activity limitation are the primary symptoms of chronic obstructive pulmonary disease and progress relentlessly as the disease advances. In COPD, dyspnea is multifactorial but abnormal dynamic ventilatory mechanics are believed to be important. Dynamic lung hyperinflation occurs during exercise in the majority of flow-limited patients with chronic obstructive pulmonary disease and may have serious sensory and mechanical consequences.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 4, Issue 3 September 2007 , pages 237 - 242
Two paradigms are commonly used to evaluate the functional limitations and restrictions imposed by the progression of COPD. The disabilities paradigm serves as a tool to evaluate a patient's functional status and details methods of managing disabilities and the health and fitness paradigm quantifies fitness and promotes physical activity as a means of regaining health. Functional capacity and physical symptoms are the most important predictors of functional performance. The functional status and disabilities models have been effective in identifying predictors of functional capacity and functional performance and to describe the effects on pulmonary rehabilitation.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 4, Issue 3 September 2007 , pages 273 - 278
Limitation of activity and impaired quality of life are important outcomes of COPD. There is an association between measures of self-reported physical activity and overall health status, and they appear to change together spontaneously over time and in response to treatment. The relationship between symptoms and activity limitation is complex, because activity can be limited entirely by symptoms, or impaired by symptoms so that it requires greater effort or causes discomfort. The patient has the choice of whether to restrict their activity or maintain it at the cost of having symptoms. In theory, this may make it difficult to produce reliable standardized assessments of activity limitation because it may not be clear exactly what is being measured.
Disease Management & Health Outcomes, Volume 15, Number 3, 2007 , pp. 165-179(15)
Asthma is a chronic condition with characteristics that make it an ideal target for interventions used within disease state management in managed care settings. It affects a substantial population of patients and imposes an increasingly significant global societal burden. Despite the availability of many asthma medications and easily accessed publications providing step-wise guidance for asthma management, there are still patients whose condition is not well controlled.
The Journal of Sexual Medicine, Volume 4, Number 5, September 2007 , pp. 1352-1357(6)
Several co-morbid diseases have been shown to affect sexual functions in both genders. In the literature, sexual function status in men with obstructive sleep apnea syndrome (OSAS) has been studied; however, sexual functions in women with OSAS have not yet been studied.
Journal of the American Geriatrics Society, Volume 55, Number 9, September 2007 , pp. 1365-1370(6)
To describe the current use of diagnostic tests for management of presumed lower respiratory tract infection in selected long-term care facilities (LTCFs) in Canada and to correlate test use with facility and resident characteristics.
Journal of the American Geriatrics Society, Volume 55, Number 9, September 2007 , pp. 1356-1364(9)
To determine the prevalence and distribution of sleep-disordered breathing and associated correlates in a large cohort of older men using several standardized definitions.
Pediatric Emergency Care. 23(8):521-527, August 2007
To compare the clinical efficacy of single-dose intramuscular (IM) dexamethasone phosphate to a 5-day course of oral prednisolone for the treatment of moderate asthma exacerbations in young children discharged from the emergency department (ED).
We investigated how mainstream smoke emissions vary and interrelate in 15 Australian and 21 Canadian brands, using public emissions disclosures from 2001. These disclosures provided emission data for 40 hazardous agents under both standard and intensive ISO testing conditions. Our analyses focused on "adjusted emissions" (i.e., emissions per milligram of nicotine yield) for 13 selected agents. Adjusted emissions differed significantly by ISO testing condition for 9 of the 13 selected agents. Intensive condition adjusted emissions were strongly negatively correlated for several agent pairs.
Am J Physiol Lung Cell Mol Physiol 293: L525-L534, 2007
Epithelial-mesenchymal transition (EMT), a process whereby fully differentiated epithelial cells undergo transition to a mesenchymal phenotype giving rise to fibroblasts and myofibroblasts, is increasingly recognized as playing an important role in repair and scar formation following epithelial injury. The extent to which this process contributes to fibrosis following injury in the lung is a subject of active investigation.
Am J Physiol Lung Cell Mol Physiol 293: L548-L554, 2007
Idiopathic pulmonary arterial hypertension (IPAH) is characterized by plexiform vascular lesions, which are hypothesized to arise from deregulated growth of pulmonary artery endothelial cells (PAEC). Here, functional and molecular differences among PAEC derived from IPAH and control human lungs were evaluated.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 4, Issue 3 September 2007 , pages 243 - 249
Activity is an essential part of life. Daily activities include caring for one's self and one's environment, moving about the home and community, and fulfilling various social roles. Personal fulfillment activities, such as interaction with others, hobbies, and attending social or entertainment events, play an important role in life satisfaction and well-being. Physical activity in the form of movement and exercise is essential for optimal fitness and health. Given these varied perspectives, what constitutes "activity" and how is it measured, both generally and in chronic obstructive pulmonary disease specifically?
Journal of Thoracic Imaging. 22(3):263-264, August 2007
The typical radiographic manifestation of bronchiolitis obliterans organizing pneumonia (BOOP) is bilateral patchy airspace opacities. We present a case of a 52-year-old man with unusual radiographic manifestation of BOOP-diffuse nodularity. We present the x-ray and computed tomography figures with pathologic findings of this case to stress the notion that BOOP should not be omitted by the differential-diagnosis of patients presenting with diffuse nodular pattern on chest imaging.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 4, Issue 3 September 2007 , pages 293 - 297
COPD exacerbations often lead to a downward spiral of physical activity. To compensate for the discomfort brought on by exertional dyspnea and the accompanying fatigue, patients with COPD will settle into a sedentary lifestyle that deconditions their bodies, serves to further aggravate breathlessness, and results in a further downward adjustment of physical activity. Progression of COPD imposes profound limitation on activities of daily living and gives rise to anxiety and depression. The distressing symptoms of breathlessness and the perception of these abnormalities by the patient lead to a reduction in health-related quality of life. The clinician's therapeutic interventions have to address these symptom and activity limitations with the goal of improving the patient's quality of life.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 4, Issue 3 September 2007 , pages 279 - 281
Patient-centered outcomes are a critical goal in the management of COPD. This personalized patient account of living with COPD indicates the importance of health-related quality of life (HRQoL) when considering the profound impact of reduced exercise tolerance on activities of daily living. The recognition of breathlessness indicating damage to the lungs from smoking and exacerbations of dyspnea associated with activity avoidance sent this patient to her clinician for a diagnosis of COPD. The eventual acceptance of her condition led to her attendance in a pulmonary rehabilitation program that made a "tremendous difference" for both the exercise and the social support it offered, and it reinforced her determination to maintain her independence and mobility that seem to contribute to a positive attitude in dealing with this challenging disease.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 4, Issue 3 September 2007 , pages 169 - 176
This paper is a post-hoc analysis of a previous study performed to investigate the relationship between computerized tomography (CT) and lung function in 51 outpatients with mild-to-moderate COPD. We studied whether changes in lung function and radiographic patterns may help to explain dyspnea, the most disturbing symptom in patients with COPD. The Medical Research Council (MRC) dyspnea scale shows, by univariate analysis, a similar strength of association to CT expiratory lung density and to DLCO, a functional index of lung parenchymal loss. The MRC dyspnea scale shows a somewhat less strength of association with a small vertical heart on plain chest films.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 4, Issue 3 September 2007 , pages 185 - 189
Chronic obstructive pulmonary disease impairs the ability of patients to perform maximal physical exercise, particularly in patients with severe lung disease. However, differing perceptions of the meaning and importance of exercise to patients and caregivers is likely to impair patient-physician communication about current medical status and outcomes of therapeutic interventions. Other outcomes of importance to patients including actual performance of functional activity during daily life and health-related quality of life may also be affected by impaired exercise capacity. However, the relationships between exercise, activity, and quality of life are inconsistent.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 4, Issue 3 September 2007 , pages 195 - 204
Patients with chronic obstructive pulmonary disease (COPD) are often caught in a downward spiral that progresses from expiratory flow limitation to poor quality of life and invalidity. Within this downward spiral, exercise tolerance represents a key intermediate outcome. As recently stated by the GOLD initiative, improvement in exercise tolerance is now rec ognized as an important goal of COPD treatment. This objective will be achieved only by a comprehensive understanding of the mechanism of exercise limitation in this disease. The objective of this paper is to review the mechanisms of exercise limitation in COPD and discuss their relative contribution to exercise intolerance in patients suffering from this disease.
Whether loss of wakefulness itself can influence pharyngeal dilator muscle activity and responsiveness is currently unknown. A study was therefore undertaken to assess the isolated impact of sleep on upper airway muscle activity after minimising respiratory/mechanical inputs.
International guidelines recommend that pulmonary reference populations consist of never-smokers without respiratory diseases or symptoms, but the diseases and symptoms are not clearly specified. The present study aimed to identify simple exclusion criteria for defining pulmonary reference populations.
The forced oscillation technique (FOT) requires minimal patient cooperation and is feasible in preschool children. Few data exist on respiratory function changes measured using FOT following inhaled bronchodilators (BD) in healthy young children, limiting the clinical applications of BD testing in this age group.
Inhaled corticosteroids (ICS) are standard treatment for persistent asthma but it is important to "step down" treatment when possible to minimise adverse effects. The optimal strategy for reducing treatment in mild asthma has not yet been determined.
The pathogenesis of severe infantile respiratory illness due to respiratory syncytial virus (RSV) and influenza virus is not fully understood. Some evidence suggests there is an increased T lymphocyte and cytokine response to infection. However, this cross-sectional study found otherwise.
Recent studies have suggested the possibility of invariant natural killer T cells (iNKT) playing an important role in the pathogenesis of asthma. To explore this hypothesis, the authors measured the numbers of iNKT in the airways of patients with stable mild/moderate asthma, patients with stable or exacerbated chronic obstructive pulmonary disease (COPD) and controls.
Oseltamivir is a neuraminidase inhibitor effective in the treatment of influenza. In this Japanese study, the sensitivity of influenza B virus to neuraminidase inhibitors was assessed in 74 children before and after treatment with oseltamivir, and in a further 348 untreated patients, 66 of whom were adults.
The first study compares the effect of three modes of ventilation on cardiovascular and respiratory physiologic variables in 14 patients with acute respiratory distress syndrome (ARDS).
To assess any relationship between the levels of ambient air pollutants and hospital admissions for chronic obstructive pulmonary disease (COPD) in Hong Kong.
Many foods are associated with chronic obstructive pulmonary disease (COPD) symptoms or lung function. Because foods are consumed together and nutrients may interact, dietary patterns are an alternative way of characterising diet. A study was undertaken to assess the relation between dietary patterns and newly diagnosed COPD in men.
The standard management of air leaks due to persistent bronchopleural fistula involves chest drainage and occasionally pleurodesis, with intractable cases requiring surgical decortication or surgical repair. However, some of these patients may be at high risk for surgery, particularly if they have already had thoracic surgery or have other medical problems; for this group there is a need for less invasive methods of stopping or reducing air leaks.
Phase I of the International Study of Asthma and Allergies in Childhood (ISAAC) was designed to allow worldwide comparisons of the prevalence of asthma symptoms. In phase III the phase I survey was repeated in order to assess changes over time.
Associations between maternal vitamin E, vitamin D and zinc intakes during pregnancy and asthma, wheeze and eczema in 5-year-old children have previously been reported. A study was undertaken to investigate whether maternal intake of specific foods during pregnancy is associated with asthma and allergic outcomes in the same children.
It is not clear whether associations between respiratory symptoms and indoor mould are causal. A randomised controlled trial was conducted to see whether asthma improves when indoor mould is removed.
Subjects with allergic asthma develop isolated late asthmatic reactions after inhalation of allergen-derived T cell peptides. Animal experiments have shown that airway hyperresponsiveness (AHR) is CD4+ cell-dependent. It is hypothesised that peptide inhalation produces increases in non-specific AHR and a T cell-dominant bronchial mucosal inflammatory response.
Severe 1-antitrypsin (AAT) deficiency is an autosomal recessive genetic condition associated with an increased but variable risk for chronic obstructive pulmonary disease (COPD). A study was undertaken to assess the impact of chronic bronchitis, pneumonia, asthma and sex on the development of COPD in individuals with severe AAT deficiency.
Journal of Thoracic Oncology. 2(8):777-779, August 2007
We introduce a case of pulmonary hyalinizing granuloma presented as a solitary pulmonary nodule located subpleurally. The patient was a 57-year-old man who had abnormal chest roentgenograms showing a solitary pulmonary nodule in the right lower lung field. The nodule was resected for definitive diagnosis and histopathologically proved to be pulmonary hyalinizing granuloma. In previously reported cases, most patients had ill-defined margins and usually bilateral, multiple lesions radiographically. In our case, the subpleural location is an uncommon location of this rare entity.
Pulmonary artery false aneurysm is a rare condition, reported to complicate interventional procedures. We report a case of a false aneurysm of the interlobar pulmonary artery following a right middle lobectomy for lung cancer. This is probably the first reported case.
European Journal of Pediatrics, Volume 166, Number 8, August 2007 , pp. 843-848(6)
This study describes the impact of undiagnosed and diagnosed asthma on quality of life in schoolchildren aged 7-10 years and their caregivers in a cross-sectional community-based study. Diagnosed asthma was defined as the parents' confirmation of a physician's diagnosis of asthma.
Soft tissue tumours and tumour-like lesions of the chest wall are uncommon. The purpose of this pictorial essay is to describe the imaging findings of chest wall soft tissue tumours and tumour-like lesions. We searched the radiological and pathological archive at our institution retrospectively and reviewed the literature on soft tissue tumours of the chest wall. Common chest wall soft tissue tumours and mass-like lesions include peripheral nerve tumours, lipomas, liposarcomas, haemangiomas, elastofibromas, metastases, lymphoma and abscesses. Other lesions encountered include desmoid tumours and malignant fibrous histiocytoma. Many have distinctive radiological findings or occur in specific locations, allowing a specific radiological diagnosis to be suggested.
The Internet Journal of Pulmonary Medicine. 2007. Volume 7 Number 2
Diffuse pulmonary lymphangiomatosis is a very uncommon disease, and is caused by abnormal development and proliferation of the lymphatic system. It is seen predominantly in children, exceptionally in adults, and affects both sexes equally. The diagnosis is usually made by biopsy. We report a case of a 26-year-old patient who presented with a 12 month history of progressive chronic cough and dyspnea. His chest CT image mimicked interstitial lung disease. Histopathologic examination showed marked thickening of the pleura with numerous dilated irregular thin-walled lymphatic vessels. The diagnosis was confirmed to be diffuse pulmonary lymphangiomatosis by lung tissue biopsy.
The Internet Journal of Pulmonary Medicine. 2007. Volume 7 Number 2
Patients with COPD have exercise limitations due to pulmonary function restrictions and heart stress, potentially producing alterations in energy levels. Adenosine triphosphate (ATP), a high-energy phosphate molecule, provides energy for the maintenance of cellular processes. D-ribose (DR), a natural occurring pentose carbohydrate, has shown to enhance ATP levels and improve cardiac function in ischemic cardiovascular disease 2 and shown benefits in lung mechanics along with ventilation in congestive heart failure patients.
Children with obstructive sleep apnea (OSA) frequently exhibit behavioral and neurocognitive problems. There is a high prevalence of OSA among obese children. This study aims to evaluate the relationship between OSA and behavioral problems in obese children as compared with normal-weight children (controls).
Cigarette smoking in college is often described as social smoking, but the term lacks definition and implicitly discounts dependence. We report on college students' use of the terms social smoker and smoker. Students who currently smoked cigarettes were asked whether they considered themselves smokers, and whether they smoked because they were social smokers.
The five-factor structure of the Nicotine Dependence Syndrome Scale (NDSS) obtained with samples of mature, heavy smokers has not been replicated in samples of younger, less experienced smokers. Furthermore, the idea that the interrelationships among the NDSS factors are best explained by a single higher-order factor (nicotine dependence) has not been evaluated empirically. This study examined the first- and second-order factor structure of the NDSS in a first-year college sample of light smokers (N = 154). NDSS measures completed at the end of the first semester of college were analyzed using confirmatory factor analysis.
This study is a randomized, double-blind, placebo-controlled clinical trial examining the effects of an intensive cognitive-behavioral mood management treatment (CBTD) and of bupropion, both singularly and in combination, on smoking cessation in adult smokers.
The Internet Journal of Pulmonary Medicine. 2007. Volume 7 Number 2
Inspiratory Muscle Training (IMT) has been studied significantly as being used for pulmonary rehabilitation for patients with obstructive lung disease. By measuring the various test subjects' on the following parameters, researchers can develop a basis to determine whether the training is successful in helping the patients improve their inspiratory muscle function: level of dyspnea based on the Borg score, maximum inspiratory pressure, number of hospitalizations due to exacerbations of their disease, inspiratory muscle strength and endurance, 6 minute walking distance, exercise tolerance, and health related quality of life (HRQL). By assessing these critical values, researchers have determined that IMT does provide a significant form of exercise for the inspiratory muscles that can improve their function and offer many other health benefits.
Liquid ventilation with perfluorocarbons is used in severe respiratory failure that cannot be managed by conventional methods. Very little is known about the use of liquid ventilation in paediatric patients with respiratory failure and there are no reports describing the distribution and excretion of perfluorocarbons in paediatric patients with severe respiratory failure.
The purpose of this study was to assess CT morphology of pneumocystis pneumonia (PcP) and cytomegalovirus (CMV) pneumonia for specific characteristic features, similarities as well as differences, which might contribute to an early diagnosis and, therefore, influence patient management.
Journal of Thoracic Imaging. 22(3):247-251, August 2007
Traumatic pulmonary pseudocyst constitutes an uncommon, though well recognized, manifestation of closed chest trauma. It is usually encountered in young patients, whose compliant chest wall permits the transmission of great compressive forces to the lung parenchyma and the laceration of the latter. Traumatic pulmonary pseudocyst is usually detected during the imaging evaluation of multi-injured patients with the use of computed tomography, as it is often not apparent in the initial supine anteroposterior chest radiographs.
Journal of Thoracic Imaging. 22(3):268-270, August 2007
It is well known that destruction of the distal capillary bed from extensive fibrosis and honeycombing in the setting of sarcoidosis may lead to pulmonary hypertension. However, we report an unusual manifestation of sarcoidosis where pulmonary hypertension resulted from granulomatous involvement of the pulmonary veins and venules. This presented as venous occlusion and intraluminal filling defects that simulated thrombus on chest computed tomography. To our knowledge, this is the first reported imaging case of such a presentation.
Although lung cancer is the top cancer killer among Filipino American men, data on tobacco-related knowledge and attitudes, cessation efforts, and preferences for smoking cessation programs among this population are lacking. We interviewed a community sample of 318 Filipino American men (110 current, 108 former, and 100 never-smokers, all immigrants) aged 40-75 years in Los Angeles County in English and Tagalog, to gain a better understanding of their tobacco use as a first step toward developing a culturally tailored smoking cessation program. In our sample, smokers had lower levels of education and income compared with nonsmokers and were less acculturated based on language use and English fluency.
The use of silver nanoparticles is rapidly growing in various industries. However, exposure to nano-sized silver particles generated during production, use, and disposal in ambient air or the workplace remains an important concern for public and occupational health. There are currently no specific methods for measuring the inhalation toxicity of nanoparticles or specific nanoparticle generation methods.
Journal of Thoracic Imaging. 22(3):300-309, August 2007
Chest radiographs have been useful for the incidental detection and initial imaging evaluation of clinically suspected central airway narrowing in pediatric patients. However, cross-sectional imaging, such as computed tomography (CT), is frequently required for confirmation of diagnosis, further characterization, and preoperative evaluation of surgical lesions. Recent rapid technologic advancement in CT has allowed CT to assume a pivotal role in the noninvasive evaluation of tracheobronchial narrowing in children, in particular with multidetector computed tomography with postprocessing techniques, including multiplanar reformations and 3-dimensional reconstructions.
Journal of Thoracic Imaging. 22(3):292-299, August 2007
Hematopoietic stem cell transplantation (HSCT) is the treatment of choice for many hematologic malignancies and nonmalignant disorders of bone marrow function. Pulmonary infections from bacterial, fungal, and viral organisms are a major cause of morbidity and mortality in patients after HSCT. The radiographic and high-resolution computed tomography (HRCT) findings of the different lower respiratory tract viral infections are quite similar.
Journal of Thoracic Imaging. 22(3):221-229, August 2007
To review the high-resolution computed tomography (CT) and histologic findings of acute exacerbation of chronic interstitial pneumonia and to assess the potential value of CT and histologic findings in predicting prognosis.
Journal of Thoracic Imaging. 22(3):230-234, August 2007
The features of 4 allogeneic bone marrow transplant patients with an unusual late-onset complication of pulmonary abnormalities with small chronic pneumothoraces are described. Thin-section computed tomography demonstrated upper zone fibrotic changes and diffuse abnormalities suggestive of constrictive obliterative bronchiolitis. An important feature of the pneumothoraces was that they tended to be recurrent and small.
Journal of Thoracic Imaging. 22(3):241-246, August 2007
To evaluate the performance of a computer-aided detection (CAD) algorithm in the detection of pulmonary nodules on high-resolution multidetector row computed tomography images in a large, homogeneous screening population, and to evaluate the effect of the system output on the performance of radiologists, using receiver operating characteristic analysis.
Journal of Thoracic Imaging. 22(3):286-291, August 2007
Smoking-related illnesses contribute to a large number of deaths in the industrialized world and their treatment comprises a substantial percentage of total healthcare dollars. The most common and most well-known smoking-related illnesses include chronic obstructive pulmonary disease, bronchogenic carcinoma, and ischemic heart disease. However, the role of cigarette smoking in the pathogenesis of other lung diseases is becoming increasingly apparent. Knowledge of both the histologic and radiographic manifestations of smoking-related lung disease is important to the radiologist as imaging findings can be nonspecific. Finally, correlation of imaging and clinical information may obviate the need for open lung biopsy.
Vascular endothelial growth factor (VEGF), a substance that stimulates new blood vessel formation, is an important survival factor for endothelial cells. Although overexpressed VEGF in the lung induces pulmonary edema with increased lung vascular permeability, the role of VEGF in the development of acute lung injury remains to be determined.
We examined the role of two regimens of combination inhaler therapy on amount of reversibility of chronic lung complications in mustard gas exposed patients. In a phase III, prospective, randomized clinical trial, 105 participants received either combination form of fluticasone propionate and salmetrol, 500/100 g daily (group 1; n = 52) or beclomethasone, 1000 g daily, and salbutamol inhaler, 800 g daily (group 2; n = 53) for 12 wk. Pulmonary function test (PFT) indices and respiratory symptoms (including dyspnea, night awakening due to dyspnea and cough) were assessed at baseline and in each visit. Thirty-six patients in group 1 and 30 patients in group 2 completed study course.
This study investigates the influence of cardiac resynchronisation therapy (CRT) on sleep disordered breathing (SDB) in patients with severe heart failure (HF).
Blood, 1 September 2007, Vol. 110, No. 5, pp. 1681-1688
The incidence of respiratory virus infection after hematopoietic cell transplantation (HCT) has probably been underestimated with conventional testing methods in symptomatic patients. This prospective study assessed viral infection episodes by testing weekly respiratory samples collected from HCT recipients, with and without symptoms reported by questionnaire, for 100 days after HCT.
Noninvasive positive pressure ventilation (NPPV) has been shown to be an effective modality for the treatment of acute or chronic respiratory failure in patients with chronic obstructive pulmonary diseases (COPD). Interest in NPPV has grown in recent years with the development of comfortable and effective masks, but the selection of an appropriate patient/ventilator interface may play a key role. Currently a variety of disposable NPPV masks are available, classified broadly as either nasal mask or face mask. Here, a case with COPD whose respiratory acidosis improved by total-face mask (TFM) was presented, and therefore we discussed the efficacy of TFM in acute respiratory failure.
Pneumonia mortality, incidence and rates of bacteremia related to CAP varies among US minority compared to White Americans. However, information on clinical features, risk for bacteremia and hospitalization costs due to CAP among minority subjects is lacking.
Infection of the respiratory tract are among the most common of human ailments. They are a substantial cause of increased morbidity and mortality rates in young children in less developed countries like India.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 513-519, (2007)
The sodium/proton exchanger (NHE) 3 is expressed in brainstem areas with prevalence for central chemosensitivity. Selective NHE3 inhibitors can evoke CO2 mimetic responses both in vitro and in vivo, demonstrating the functional significance of this pH-regulating protein. Moreover, levels of NHE3 expression are inversely correlated to interindividual differences of baseline ventilation in conscious rabbits.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 483-490, (2007)
Patients with severe sepsis frequently receive prophylactic heparin during drotrecogin alfa (activated) (DrotAA) treatment due to risk of venous thromboembolic events (VTEs). Biological plausibility exists for heparin to reduce DrotAA efficacy and/or increase bleeding.
Journal of Thrombosis and Haemostasis, Volume 5, Number 9, September 2007 , pp. 1869-1877(9)
Age has a marked effect on the diagnostic yield of D-dimer measurement and lower limb compression ultrasonography (CUS) in patients with suspected pulmonary embolism (PE), suggesting that specific diagnostic strategies may be needed in elderly patients.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 446-453, (2007)
Although it is widely assumed that the incidence of childhood respiratory allergies to common aeroallergens is directly related to allergen exposure in early life, few longitudinal studies have investigated this issue, and available data are scarce and mainly limited to high-risk groups.
Journal of Sleep Research, Volume 16, Number 3, September 2007 , pp. 313-318(6)
The association of papilloedema (PO) with respiratory diseases and especially obstructive sleep apnoea (OSA) syndrome has been emphasised in many reports. The pathophysiology could rely on the episodic increase of intracranial pressure related to apnoeic episodes during night sleep.
Ambient air particulate matter (PM) originates as either primary particles emitted directly into the atmosphere from a specific source or as secondary particles produced from atmospheric chemical reactions between precursor gases or between these gases and primary particles.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 460-464, (2007)
The presence of airway obstruction is currently defined by Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines on the basis of the post-bronchodilator (BD) FEV1/FVC. It has been proposed that the traditional FVC can be replaced with the shorter and less demanding FEV6 for detecting airway obstruction.
Smokers with smoking-related diseases who are hospitalized in rehabilitation centers should be offered smoking cessation. This is the first study evaluating whether telephone booster sessions after intensive inpatient treatment are an effective strategy. The present study was conducted in 13 rehabilitation centers for somatic disorders as a prospective multicenter study with a randomized treatment-control group design.
Chronic exposure to chlorine gas has been shown to cause occupational asthma. Acute inhalation of chlorine is known to cause airway inflammation and induce airway nitric oxide formation. Exhaled nitric oxide may therefore be a marker of airway damage after chlorine gas exposure. After accidental chlorine gas exposure in a swimming pool, exhaled nitric oxide and pulmonary function were repeatedly measured in 18 children over a 1-mo period.
Sufficient variation exists in how people smoke each cigarette that the number of cigarettes smoked daily and the years of smoking represent only crude measures of exposure to the toxins in tobacco smoke. Previous research has shown that spent cigarette filters can provide information about how individuals smoke cigarettes.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 454-459, (2007)
Patients with severe (GOLD-3) and very severe (GOLD-4) COPD (n = 101) were studied after lung volume reduction surgery. Respiratory symptoms, quality of life, pulmonary function, exercise tolerance, chest radiology, and corticosteroid treatment status were assessed preoperatively. The severity of luminal occlusion, wall thickening, and the presence of small airways containing lymphoid follicles were determined in resected lung tissue. Kaplan-Meier survival analysis and Cox proportional hazards models were used to determine the relationship between survival and small airway pathology. The effect of corticosteroids on this pathology was assessed by comparing treated and untreated groups.
Journal of Sleep Research, Volume 16, Number 3, September 2007 , pp. 327-332(6)
The aim of this study was to investigate the relationships among sympathetic hyperactivity, excessive daytime sleepiness (EDS) and hypertension in obstructive sleep apnoea syndrome (OSAS). Ten newly diagnosed OSAS patients with untreated EDS and daytime hypertension underwent polysomnography (PSG) and daytime measurements of plasma noradrenaline (NA), ambulatory blood pressure (BP), muscle sympathetic nerve activity (MSNA) by microneurography and objective assessment of EDS before and during 6 months of compliance-monitored continuous positive airway pressure (CPAP) treatment.
Respiratory syncytial virus (RSV) is a leading cause of infant mortality worldwide. Although anti-RSV Ab prophylaxis has greatly reduced infant mortality in the United States, there is currently no vaccine or effective antiviral therapy. RSV fusion (F) protein activates cells through TLR4. Two single nucleotide polymorphisms (SNPs) encoding Asp299Gly and Thr399Ile substitutions in the TLR4 ectodomain were previously associated with TLR4 hyporesponsiveness and increased susceptibility to bacterial infection.
Non-cardiogenic pulmonary oedema is an uncommon complication of both methadone and heroin overdose, often requiring a period of invasive ventilation due to its severity. We report the successful, early use of non-invasive ventilation in the management of non-cardiogenic pulmonary oedema secondary to a non-fatal overdose of oral methadone.
We tested whether methylation profiles generated by real-time methylation-specific PCR (MSP) can be useful in differentiating benign, reactive mesothelial cell proliferation (RM) from malignant mesothelioma (MM).
To compare the content of neutrophils, macrophages, lymphocytes and mast cells infiltrating LA and SA in smokers who underwent surgery for lung cancer.
The Internet Journal of Anesthesiology. 2007. Volume 13 Number 2.
Deep venous thrombosis and pulmonary embolism are some of the early postoperative complications following prostatectomy1. If the embolism is massive and not recognized and treated specifically, it can be rapidly fatal. Here we give a case report of a patient who presented with early postoperative cardiac arrest, and was diagnosed as acute pulmonary thromboembolism and managed. The diagnosis and management of perioperative pulmonary embolism is discussed.
Chronic respiratory insufficiency is inevitable in the course of disease progression in patients with Duchenne muscular dystrophy (DMD). Without mechanical ventilation (MV), morbidity and mortality are highly likely towards the end of the second decade of life. The present review reports evidence and clinical implications regarding DMD patients treated with MV.
Idiopathic pulmonary fibrosis (IPF) remains the most common of the idiopathic interstitial pneumonias and portends a poor prognosis. Significant strides have been made in the approach to diagnosis and in the ability to predict outcome in the last few years. Advances in high-resolution CT (HRCT) scanning have allowed an accurate diagnosis obviating the need for surgical biopsy in many patients. Furthermore, HRCT scanning may aid in determining prognosis and identifying disease progression.
In a 6-month, randomized, double-blind study published in the International Journal of Clinical Practice, the use of budesonide/formoterol as both maintenance and reliever therapy was demonstrated to provide better asthma control than either salmeterol/fluticasone plus terbutaline as needed or a fixed maintenance dose of budesonide/formoterol plus terbutaline as needed.
Journal of Intensive Care Medicine, Vol. 22, No. 4, 232-239 (2007)
Dysfunction of the vascular endothelium (ET) causes an increase in serum ET-1 concentration, as observed in septic patients. It was assumed that in this patient population the ET-1 level correlates with the degree of sepsis severity, including the level of organ dysfunction and, in particular, the level of circulatory dysfunction.
Cough is an important defensive reflex of the respiratory tract needed to clear and protect the upper airways; however, it may become exaggerated and interfere with quality of life. Although chronic cough may be successfully treated when associated with the common causes such as asthma and eosinophilic bronchitis, gastrooesophageal reflux disease and post-nasal drip syndrome or rhinosinusitis, increasingly, idiopathic cough or cough with no associated cause is recognised.
The outcomes of quantitative investigations examining the effectiveness of exercise interventions for people with COPD are limited by the small number of measurement tools that can be included. In contrast, qualitative inquiry allows broader exploration of the perceived outcomes of an intervention.
Spirometry is available in most GP surgeries and provides an invaluable tool for assessing respiratory function in chronic obstructive pulmonary disease (COPD) and asthma. Spirometry alone may not provide the clinician with an accurate assessment of lung disease as it misses two important measurements of lung volume. By measuring Residual Volume (RV) and Total Lung Capacity (TLC) it is possible to determine true restrictive or hyperinflated disease processes.
Patients with chronic obstructive pulmonary disease (COPD) are often given a prescription for a short course of oral steroids and antibiotics for self-administration during an acute exacerbation. The main objective of this study was to determine the impact of such prescriptions on medical care utilization, and steroids and antibiotics intake. This retrospective cohort study included patients with moderate to severe COPD participating in a self-management programme.
Occup Environ Med. Published Online First: 11 July 2007
To identify the effects of indium on the lung and to assess exposure-effect and exposure-response relationships between indium exposure and effects on the lungs. Study design: A cross-sectional study.
Background: Recently, continuous monitoring of cardiac output (CO) based on pulse contour analysis (Vigileo) has been introduced into practice. In this clinical study, we evaluated the accuracy of this system by comparing it with the transpulmonary thermodilution technique (TPID) in septic patients.
Intra-abdominal hypertension is common in critically ill patients and is associated with increased severity of organ failure and mortality. The techniques most commonly used to estimate intra-abdominal pressure are measurements of bladder and gastric pressures. The bladder technique requires that the bladder be infused with a certain amount of saline, to ensure that there is a conductive fluid column between the bladder and the transducer. The aim of this study was to evaluate the effect of different volumes and temperatures of infused saline on bladder pressure measurements in comparison with gastric pressure.
The prevalence of noncommunicable diseases in Eritrea is increasing. Tobacco use is a recognized risk factor for most of these diseases, especially cardiovascular disease. No data have been published on tobacco use in Eritrea. The present study sought to establish the prevalence of tobacco smoking in Eritrea. The World Health Organization STEPwise approach was used for the survey, conducted in 2004 on a random national sample size of 2,460 subjects (response rate = 93.7%).
International Journal of Geriatric Psychiatry 6 Mar 2007
Although lower respiratory tract infections (LRI) cause considerable morbidity and mortality among nursing home residents with dementia, the effects of care and treatment are largely unknown. Few large prospective studies have been conducted.
To retrospectively determine sensitivity and specificity of four findings for distinguishing pulmonary infarction from other causes of peripheral pulmonary consolidations on multidetector computed tomographic (CT) images, with other CT and clinical findings as reference.
Oxidative stress plays an important role in the pathogenesis of some diseases such as lung cancer, chronic obstructive pulmonary disease, and atheroscleorosis. Smoking may enhance oxidative stress not only through the production of reactive oxygen radicals in smoke but also through weakening of the antioxidant defense systems. In this study, we investigated the effects of smoking on lipid peroxidation and paraoxonase activity in a healthy population.
Journal of Thoracic Oncology. 2(7):673-675, July 2007
We report the devastating complication of constrictive pericarditis after multimodality therapy including left extrapleural pneumonectomy for malignant pleural mesothelioma. The patient presented with progressive dyspnea, ascites, and peripheral edema 6 months after receiving adjuvant radiotherapy. A diagnosis of constrictive pericarditis was made late in the clinical course after exhaustive investigation to exclude primary disease recurrence. Pericardial decortication was subsequently undertaken 12 months after the initial surgery, but the patient died of multi-organ failure.
Journal of Thoracic Oncology. 2(7):660-661, July 2007
We present a case of recurrent primary synovial sarcoma of the chest wall in a 55-year-old man. Imaging at the time of recurrence revealed extensive involvement of the left pleural cavity by the tumor. The patient developed severe congestive heart failure with restrictive/constrictive physiology and subsequently died in the hospital 5 months after initial presentation. At autopsy, the tumor encased the entire left lung in a rind-like fashion and diffusely involved the pericardium.
Since its origins in the 1970s, source apportionment using receptor modeling has improved to a point where both the chemical mass balance and various methods of factor analysis have been applied to many urban and regional data sets to infer major sources or source classes influencing airborne particle concentrations. Recently the factors from the latter analyses have been combined with regression techniques using human health endpoints to infer source influence on health effects.
Journal of Thoracic Oncology. 2(7):663-670, July 2007
The terms pleuroscopy, thoracoscopy, medical thoracoscopy, and video-assisted thoracic surgery are often used interchangeably to describe a minimally invasive procedure that provides access to the pleural space, parietal pleura, lung, and other structures within the thoracic cavity. Pleuroscopy is a more exact term for describing visualization of the pleura and contents of the pleural cavity using an endoscope. This procedure provides physicians a window into the pleural space, to perform biopsy of the parietal pleura under direct visual guidance, particularly for biopsies in cases of exudative effusions with unclear origin, chest tube placement, and pleurodesis to prevent recurrent pleural effusion or pneumothorax in selected patients.
Abstract
Environmental tobacco smoke (ETS) contains carcinogenic and toxic agents. Smoking might have a more serious effect on children than adults. We aimed to examine the effects of passive smoking on pulmonary function and respiratory health in children and to assess the concordance between parental self-reported smoking habits and urinary cotinine levels in their children. This cross-sectional study was conducted in the winter with the participation of 131 children (9-12 yr old).
International Archives of Allergy and Immunology 2008;145:43-47
FYN is nonreceptor tyrosine kinase that represents the earliest detectable signaling response after antigen-activated inflammatory cells. Studies in animal models of allergic asthma have shown that inhibitors of tyrosine kinases exert an anti-inflammatory effect. In the FYN gene, several polymorphisms have been described. There have, however, been no studies analyzing the impact of FYN gene polymorphisms on the course and severity of asthma. The aim of this study was to analyze the possible relationship between three polymorphisms (-93A/G, Intron10+37C/T and Ex12+894T/G) in the FYN gene and asthma.
Diabetes, Obesity and Metabolism, Volume 9, Number 5, September 2007 , pp. 679-687(9)
To observe the effect of constant positive airway pressure (CPAP) therapy on regional lipid deposition, muscle metabolism and glucose homeostasis in obese patients with obstructive sleep apnoea syndrome (OSAS).
The Journal of Infectious Diseases 2007;196:826-834
Respiratory syncytial virus (RSV) is a common cause of severe lower respiratory tract infection in infants. Only a proportion of children infected with RSV require hospitalization. Because known risk factors for severe disease, such as premature birth, cannot fully explain differences in disease severity, genetic factors have been implicated.
To evaluate the clinical features and survival data of patients with idiopathic pulmonary arterial hypertension (PAH) and familial PAH in Chinese patients.
Systemic sclerosis (SSc) is a connective tissue disorder of unknown etiology that is often complicated by pulmonary involvement, with pulmonary hypertension (PH) and interstitial lung disease (ILD) being the major causes of death. It has been suggested that the amount of nitric oxide (NO) in exhaled air may predict the onset of complications. The aim of the study was to measure exhaled NO in SSc patients and investigate its relationship with pulmonary involvement with and without PH.
To elucidate the frequency of infections with pathogenic respiratory bacteriae during an inter-epidemic period a multiplex PCR assay was used to screen nasopharyngeal smears for the presence of DNA specific for Bordetella pertussis, Bordetella parapertussis, Chlamydophila pneumoniae and Mycoplasma pneumoniae. 187 samples from children aged 2-14 y were analysed with this method in addition to classical bacteriology and compared to results obtained with commercially available PCR kits for each single parameter.
Clinical Physiology and Functional Imaging, Volume 27, Number 5, September 2007 , pp. 327-334(8)
Bronchial hyperresponsiveness (BHR) is common in bakery workers. The relation between bronchial responsiveness measured with a tidal breathing method and smoking, airway symptoms, IgE-sensitization, nasal indices of inflammation and flour dust exposure have been studied with bronchial responsiveness expressed as a continuous outcome.
The objective of the study was to characterize the biological and technical components of variability associated with longitudinal measurements of FEV1 and carbon monoxide diffusing capacity (DLCO). Variability was apportioned to subject and instrument for five commercially available pulmonary function testing (PFT) systems: Collins CPL (Ferraris Respiratory; Louisville, CO); Morgan Transflow Test PFT System (Morgan Scientific; Haverhill, MA); SensorMedics Vmax 22D (VIASYS Healthcare; Yorba Linda, CA); Jaeger USA Masterscreen Diffusion TP (VIASYS Healthcare; Yorba Linda, CA); and Medical Graphics Profiler DX System (Medical Graphics Corporation; St. Paul, MN).
The objective of the study was to quantify the accuracy and reproducibility of five commercially available pulmonary function test (PFT) instruments (Collins CPL [Ferraris Respiratory; Louisville, CO]; Morgan Transflow Test PFT System [Morgan Scientific; Haverhill, MA]; SensorMedics max 22D [VIASYS Healthcare; Yorba Linda, CA]; Jaeger USA Masterscreen Diffusion TP [VIASYS Healthcare]; and Medical Graphics Profiler DX System [Medical Graphics Corp; St. Paul, MN]) that are associated with spirometry and the measurement of pulmonary diffusing capacity.
Altitude-induced pulmonary hypertension has been suggested to cause left ventricular (LV) diastolic dysfunction due to ventricular interaction. In this study, we evaluate the effects of exercise- and altitude-induced increase in pulmonary artery pressures on LV diastolic function in an interventional setting investigating high-altitude pulmonary edema (HAPE) prophylaxis.
Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 11, No. 2, 137-148 (2007)
Pulmonary arterial hypertension (PAH) is a progressive disease of the pulmonary vasculature, characterized by relentless deterioration and death. Patients with PAH are known to be at increased risk for anesthetic complications and surgical morbidity and mortality. However, outcomes in patients have improved with the recent development of new drug therapies.
To evaluate the extent to which oximetry, spirometry and dyspnea scoring can reflect hypoxemia and hypercapnia among patients admitted to the emergency department (ED) with acute exacerbations of chronic obstructive pulmonary disease.
In vitro models of the alveolo-pulmonary barrier consist of microvascular endothelial cells and alveolar epithelial cells cultured on opposing sides of synthetic porous membranes. However, these simple models do not reflect the physiological microenvironment of pulmonary cells, wherein cells are exposed to a complex milieu of mechanical and soluble stimuli.
Pediatric & Child Health July/ August 2007, Volume 12, Number 6:473-477
Croup is a common childhood illness. The majority of children presenting with an acute onset of barky cough, stridor and indrawing have croup. A careful history and physical examination is necessary to confirm the diagnosis of croup, and to rule out potentially serious alternative causes of upper airway obstruction.
Clinical Physiology and Functional Imaging, Volume 27, Number 5, September 2007 , pp. 284-290(7)
Although various factors influence peripheral circulation in chronic obstructive pulmonary disease (COPD) patients, little is known about the vasomotor changes in these subjects. The present study was designed to assess alterations in the brachial circulation of COPD patients.
To retrospectively establish the minimum increase in emphysema score (ES) required for detection of real increased extent of emphysema with 95% confidence by using multi-detector row computed tomography (CT) in a lung cancer screening setting.
Primary Care Respiratory Journal Volume 16 Issue 4 August 2007
A number of clinicopathological manifestations may define the presence of hypersensitivity pneumonitis. Histological study is used to establish the diagnosis and to differentiate the disease from other respiratory disorders. This case report suggests that immunohistological demonstration of the causative antigen in the lung may be a useful diagnostic approach in cases of pigeon hypersensitivity pneumonitis.
Primary Care Respiratory Journal Volume 16 Issue 4 August 2007
This study was designed to capture patient preferences for different aspects of asthma treatment from people with asthma in the UK, the Netherlands and Spain.
Canadian Respiratory Journal July/ August 2007, Volume 14, Number 5: 269-275
To compare the cost-effectiveness of budesonide-formoterol in a single inhaler used as both maintenance and reliever medication versus clinician-directed titration of salmeterol-fluticasone as maintenance medication, plus salbutamol taken as needed, in controlling asthma in adults and adolescents.
Primary Care Respiratory Journal Volume 16 Issue 4 August 2007
Valved holding chambers (VHCs) are prescribed with pressurised metered dose inhalers (pMDIs) to improve medication delivery for the treatment of respiratory diseases because they reduce the need for the patient to co-ordinate inhaler actuation with the onset of inhalation.
Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 11, No. 2, 119-136 (2007)
Pulmonary artery hypertension is defined as persistent elevation of mean pulmonary artery pressure > 25 mm Hg with pulmonary capillary wedge pressure < 15 mm Hg or elevation of exercise mean pulmonary artery pressure > 35 mm Hg. Although mild pulmonary hypertension rarely impacts anesthetic management, severe pulmonary hypertension and exacerbation of moderate hypertension can lead to acute right ventricular failure and cardiogenic shock.
Canadian respiratory Journal July/ August 2007, Volume 14, Number 5: 276-280
Diagnosis of occupational asthma (OA) by specific inhalation challenge (SIC) can be costly and is not always available. The use of sputum testing to avoid this in some patients may be a more cost-effective alternative.
To retrospectively evaluate the causes of discordant computed tomographic (CT)–angiographic readings from the Prospective Investigation of Pulmonary Embolism Diagnosis, or
PIOPED, II study.
Candian Respiratory Journal July/ August 2007, Volume 14, Number 5: 285-291
Both ventilation (V) and perfusion (Q) of the lungs are altered in asthma, but their relationships with allergen-induced airway responses and gas exchange are not well described.
Children with obstructive sleep apnea (OSA) frequently exhibit behavioral and neurocognitive problems. There is a high prevalence of OSA among obese children. This study aims to evaluate the relationship between OSA and behavioral problems in obese children as compared with normal-weight children (controls).
Primary Care Respiratory Journal Volume 16 Issue 4 August 2007
Despite guideline recommendation, influenza vaccination rates among asthmatic patients remain low. The objective of this study was to identify health beliefs associated with vaccination adherence in asthmatic patients.
Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 11, No. 2, 149-156 (2007)
The presence of pulmonary hypertension affects lung transplantation in multiple ways, from patient selection, transplant risks, type of transplant, intraoperative management, to transplant outcome. A working knowledge of natural disease progression, the latest medical treatment options, and transplant outcome is critical in patient selection, and a good understanding of the transplant process, including the new transplant allocation system, is important for physicians involved in the care of patients with pulmonary arterial hypertension.
Primary Care Respiratory Journal Volume 16 Issue 4 August 2007
The aim of this study was to clarify the association between obstructive sleep apnoea/hypopnoea syndrome (OSAHS)-related symptoms and physician-diagnosed asthma and COPD.
Canadian Respiratory Journal July/ August 2007, Volume 14, Number 5: 281-284
Exacerbations of airway disease are eosinophilic, neutrophilic, both or neither. The primary objective of the present study was to identify whether the treatment of a neutrophilic bronchitis can unmask an associated eosinophilia.
Allergy, Volume 62, Number 9, September 2007 , pp. 1064-1070(7)
The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines provide a stepwise treatment to rhinitis, which classifies the disease according to its duration and severity.
The Proceedings of the American Thoracic Society 4:461-464 (2007)
Activated pulmonary CD4+ T lymphocytes of the Th-1 type are essential for the inflammatory process in sarcoidosis, and IFN- production is crucial for the characteristic granuloma formation. Both the T cells and their inflammatory mediators may constitute possible targets for immunotherapy. A particular T-cell subset, the T-cell receptor (TCR) AV2S3+ bronchoalveolar lavage (BAL) CD4+ T cells, is found at dramatically increased levels in the BAL fluid of human leukocyte antigen (HLA)-DRB1*0301-positive and/or HLA-DRB3*0101-positive patients with sarcoidosis.
The Proceedings of the American Thoracic Society 4:465-468 (2007)
The etiology of sarcoidosis remains uncertain. The hallmark of sarcoidosis is the epithelioid granuloma, which serves as a necessary starting point for considering disease etiology. Any etiologic agent of sarcoidosis must also explain the typical clinical behaviors and characteristic immunopathologic features of the disease. One clinical observation that serves as a bridge to the etiology of sarcoidosis is the Kveim reaction.
Tidal expiratory flow limitation (EFL) contributes to chronic dyspnea and exercise intolerance in COPD patients. It can be assessed with the negative expiratory pressure (NEP) technique and is expressed as either the percentage of the tidal volume over which EFL occurs (EFL%VT) or according to more detailed three-point or five-point scoring systems. The aim of this study was to evaluate the reproducibility of the NEP technique in COPD patients.
American Journal of Respiratory Cell and Molecular Biology. Vol. 37, pp. 273-290, 2007
Mucus hypersecretion contributes to morbidity and mortality in many obstructive lung diseases. Gel-forming mucins are the chief glycoprotein components of airway mucus, and elevated expression of these during mucous metaplasia precedes the hypersecretory phenotype. Five orthologous genes (MUC2, MUC5AC, MUC5B, MUC6, and MUC19) encode the mammalian gel-forming mucin family, and several have been implicated in asthma, cystic fibrosis, and chronic obstructive pulmonary disease pathologies.
American Journal of Respiratory Cell and Molecular Biology. Vol. 37, pp. 264-272, 2007
We quantified the effects of airway wall remodeling upon airway smooth muscle (ASM) shortening. Isolated ASM from sheep was attached to a servo-controller that applied a physiologic load. This load could be altered to reflect specified changes of airway wall geometry, elasticity, parenchymal tethering, transpulmonary pressure (PL), and fluctuations in PL associated with breathing.
The rate of infection in patients who require ventricular assist devices is estimated at more than 35%. Infections with multi-resistant organisms such as methicillin-resistant Staphylococcus aureus in ventricular assist device recipients are often difficult to treat and present a high mortality rate. Daptomycin is a new cyclic lipopeptide antibiotic, useful in gram-positive organisms resistant to standard treatment. We report a case of a 65-year-old man suffering from a dilatative cardiomyopathy and concomitant MRSA infection who received a biventricular assist device. The patient had MRSA sepsis develop resistant to conventional therapy, which was successfully treated with daptomycin.
Cardiac resynchronization therapy (CRT) has been shown to improve cardiac function and reduce Cheyne-Stokes respiration but has not been evaluated in patients with obstructive sleep apnea (OSA). In this pilot study, we investigated the impact of both CRT and CRT plus increased rate pacing in heart failure (ie, congestive heart failure [CHF]) patients with OSA. We hypothesized that through increased cardiac output CRT/pacing would reduce obstructive events and daytime symptoms of sleepiness.
COPD is a significant cause of morbidity and mortality. Guidelines recommend the confirmation of a COPD diagnosis with spirometry. Limited evidence exists, however, documenting the frequency of spirometry use in clinical practice.
Patients with COPD have decreased exercise capacity and low oxygen consumption (O2) during formal cardiopulmonary exercise testing, and lower scores on health-related quality of life questionnaires. When isolated, these three variables show different correlations with COPD mortality. The multidimensional BODE (body mass index[BMI], airflow obstruction, dyspnea, and exercise capacity in COPD) index, which comprises four variables including the 6-min walk test (6MWT), predicts survival in COPD.
Upper airway edema might contribute to pharyngeal collapsibility and account for the high prevalence of obstructive sleep apnea (OSA) in patients with heart disease. The aim of this study was to evaluate if intensive unloading with diuretics improves sleep-disordered breathing and increases pharyngeal caliber in patients with severe OSA and diastolic heart failure.
Respiratory myoclonus or diaphragmatic flutter is an unusual movement disorder with abnormal diaphragmatic activity, which may be associated with respiratory symptoms. The effects of distracting maneuvers on diaphragmatic activity have not been investigated.
As modern health care continues to evolve, we expect and are seeing that more sophisticated medical care will be provided outside the traditional acute care environments. Advances in home medical technology, economic pressures, health-care consumerism, and societal changes are all factors playing a role in this evolution. Medically fragile and technology-dependent individuals who were once limited to care in acute and subacute institutional settings are now frequently cared for at home, most often by their immediate family members.
In patients with Systemic lupus erythematosus (SLE), Raynaud phenomenon (RP) is frequently present and associated with pulmonary hypertension (PHT). Elevated pulmonary artery systolic pressure (PASP) is an indicator of PHT and can be estimated noninvasively. We attempt to explore the significance of RP in SLE and to correlate it with clinical and serological parameters of the disease.
Chylothoraces are associated with multiple etiologies including non-Hodgkin lymphoma and surgical trauma, representing 50% and 25% of all chylothoraces, respectively. Intrathoracic operations such as repair of coarctation of the aorta and esophagectomy are commonly associated with surgical trauma. Idiopathic chylothoraces may account for up to 15% of all chylothoraces. When a thorough evaluation finding is negative, further history to identify possible blunt, nonpenetrating trauma to the chest is warranted.
Systemic air embolism is recognized as a potentially fatal but extremely rare complication following percutaneous transthoracic needle biopsy. However, its incidence might be underestimated by missing systemic air in patients without cardiac or cerebral symptoms.
Nitric oxide (NO) is produced by a variety of cells within the respiratory tract, particularly airway epithelial cells, and its increased concentration in asthma is likely to derive from inducible NO synthase (iNOS) expressed in inflamed airways. To evaluate whether an increased bronchial flux of NO (ie, airway wall NO flux [JNO] in picoliters per second) produced in the large airways is due to an enzyme overexpression, we administered a relatively selective iNOS inhibitor, aminoguanidine, by nebulization in a double-blind, placebo-controlled manner in asthmatic and healthy subjects and also investigated whether the same concentration of inhibitor has any effect on NO produced in the peripheral lungs (ie, alveolar NO concentration [CALV] in parts per billion [ppb]) or on the diffusing capacity of NO (DNO) [in picoliters per second-1 per ppb-1) in the airways.
Measurement of inflammatory mediators in exhaled breath condensate (EBC) is an easy and noninvasive diagnostic method, which has gained popularity in the past few years. However, the source of these mediators is not precisely defined. It has been only presumed that inflammatory cells present in the airway lumen are the main source. Therefore, the aim of this study was to verify the relationship between EBC and BAL fluid (BALF) eicosanoids, and the percentage, number, and activity of cells in BALF.
The risk factors for venous thromboembolism (VTE) following lung transplantation are not well established. We aimed to estimate the incidence of VTE and to identify the risk factors for VTE after lung transplantation.
Journal of Trauma-Injury Infection & Critical Care. 63(2):344-350, August 2007
Elderly patients have become an increasingly prevalent proportion of the intensive care unit population. Outcomes of patients with acute respiratory distress syndrome (ARDS) have been improving in recent years, but studies of ARDS rarely include substantial numbers of elderly patients. Historically, the mortality rate for ARDS has been 69% to 80% among elderly patients. We reviewed our experience with ARDS to determine whether outcomes were improving over time, and in particular whether outcomes were equally favorable among our elderly patients aged 65 years or older.
Noninvasive ventilation (NIV), the provision of ventilatory assistance without an artificial airway, has emerged as an important ventilatory modality in critical care. This has been fueled by evidence demonstrating improved outcomes in patients with respiratory failure due to COPD exacerbations, acute cardiogenic pulmonary edema, or immunocompromised states, and when NIV is used to facilitate extubation in COPD patients with failed spontaneous breathing trials.
Oral appliances for the treatment of obstructive sleep apnea (OSA) are worn during sleep to maintain the patency of the upper airway by increasing its dimensions and reducing its collapsibility. Oral appliances are a simpler alternative to continuous positive airway pressure (CPAP). Over the last decade, there has been a significant expansion of the evidence base to support the use of oral appliances, with robust studies demonstrating their efficacy. This work has been underpinned by the recognition of the importance of upper airway anatomy in the pathophysiology of OSA.
Peak expiratory flow (PEF) monitoring is frequently used to diagnose occupational asthma (OA). The variability of PEF between periods at work and away from work has not been described in workers with work-exacerbated asthma (WEA). We sought to assess and compare the diurnal variability of PEF during periods at and away from work between subjects with OA and WEA.
Clinical decisions which impact directly on patient safety and quality of care are made during acute asthma attacks by individual doctors based on their knowledge and experience. Decisions include administration of systemic corticosteroids (CS) and oral antibiotics, and admission to hospital. Clinical judgement analysis provides a methodology for comparing decisions between practitioners with different training and experience, and improving decision making.
Current Opinion in Pulmonary Medicine. 13(5):377-383, September 2007
Recently, studies on large diverse populations have described important ethnic/racial differences in venous thromboembolism incidence, and sex has been reported as an important predictor of recurrence. We review the influence of race/ethnicity and sex on venous thromboembolism, concentrating on articles from 2005 to 2007.
Pediatric Allergy and Immunology, Volume 18, Number 6, September 2007 , pp. 469-474(6)
The evidence for hypothalamic-pituitary-adrenal axis (HPA) suppression by inhaled corticosteroids (ICS) was found to be conflicting. Reviewers have not distinguished between gold standard and basal adrenal function tests. The utility of the latter is limited by physiological and pathological variability as well as by methodological concerns. The risk of HPA suppression in asthmatic children and adolescents treated with ICS, as determined by gold standard adrenal function tests, needs to be established.
Pneumonia viruses such as influenza may potentially spread by airborne transmission. We studied the dispersion of exhaled air through a simple oxygen mask applied to a human patient simulator (HPS) during the delivery of different oxygen flow in a room free of air currents.
Asthma is chronic airway inflammation that occurs together with reversible airway obstruction. T-lymphocytes play an important role in the pathogenesis of asthma. Proteomic technology has rapidly developed in the postgenomic era, and it is now widely accepted as a complementary technology to genetic profiling. We investigated the changes of proteins in T-lymphocytes of asthma patients by using standard proteome technology: two-dimensional polyacrylamide gel electrophoresis (2D-PAGE), matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS), and a database search.
The hallmark of COPD is airflow obstruction, but this can develop on the basis of airway disease, emphysema, or both. There are gender differences in the natural history of COPD, and these may in part be explained by differences in the pathophysiology of airflow obstruction. We aimed to determine if there are gender differences in the severity of CT emphysema among COPD patients.
Interstitial lung diseases (ILDs), a broad heterogeneous group of parenchymal lung disorders, can be classified into those with known and unknown causes. The definitions and diagnostic criteria for several major forms of ILDs have been revised in recent years.
The exercise challenge test (ECT) is a common tool to assess exercise-induced asthma (EIA) in school-aged children. EIA has not been explored in the early childhood setting.
Bacterial pulmonary infection is a common life-threatening complication in immunocompromised patients. The results of BAL cultures are not immediately available, and their microbiological yield might be limited by empiric antibiotic prescriptions. We evaluated clinical signs and symptoms, leukocyte counts, C-reactive protein (CRP) levels, procalcitonin levels, and BAL fluid neutrophil percentages as potential markers for bacterial infection in a cohort of immunocompromised patients with pulmonary complications.
Massive pulmonary embolism (PE) is a life-threatening condition with a high early mortality rate due to acute right ventricular failure and cardiogenic shock. As soon as the diagnosis is suspected, an IV bolus of unfractionated heparin should be administered. In addition to anticoagulation, rapid initiation of systemic thrombolysis is potentially life-saving and therefore is standard therapy.
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