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Respiratory Medicine Volume 100, Issue 7 , July 2006, Pages 1282-1285
The aim of this study was to examine the effects of age, sex and social deprivation on mortality rates for respiratory infection. An ecological study was undertaken, using official public health mortality data and population census data for the West Midlands health region, UK. Postcodes at the time of death were used to assign Townsend deprivation scores and the resulting deprivation quintile. Poisson regression analysis was used to estimate the association between respiratory mortality, deprivation quintile, age and sex.
Respiratory Medicine Volume 100, Issue 7 , July 2006, Pages 1247-1253
We examined pulmonary diffusing capacity (DLCO) and its partition in pulmonary vascular diseases without evident parenchymal disease to assess the pattern and proportionality of change in membrane diffusion (Dm) and capillary blood volume (Vc). Disproportionate reduction in Dm relative to Vc (low Dm/Vc) in these diseases has been attributed to associated alveolar membrane/parenchymal disease, thus providing a potentially important diagnostic tool.
Respiratory Medicine Volume 100, Issue 7 , July 2006, Pages 1270-1276
Chronic obstructive pulmonary disease (COPD) is a slowly progressive condition characterised by poorly reversible airflow limitation associated with an abnormal inflammatory response of the lung. The main causal factors of COPD are chronic oxidative stress as a result of long-term smoking, use of biomass fuels, and air pollution. In this study, basal levels of DNA strand breaks were investigated together with some additional oxidative markers implicating oxidative damage on the other biomolecules such as proteins and lipids in patients with COPD who were exposed to smoking and biomass.
Journal of Allergy and Clinical Immunology Volume 117, Issue 6 , June 2006, Pages 1277-1284
There is compelling evidence that human mast cells contribute to the pathophysiology of asthma. Mast cells, but not T cells or eosinophils, localize within the bronchial smooth muscle bundles in patients with asthma but not in normal subjects or those with eosinophilic bronchitis, a factor likely to be important in determining the asthmatic phenotype. The mechanism of mast cell recruitment by asthmatic airway smooth muscle involves the CXCL10/CXCR3 axis, and several mast cell mediators have profound effects on airway smooth muscle function.
Sleep apnea is very common--an estimated 12 million Americans have been diagnosed with the condition. Because sleep apnea frequently goes undiagnosed, many experts agree that millions more Americans could have the condition.1-3 In general, sleep apnea occurs more often in males than females (approximately 24% of males and 9% of females have sleep apnea) and in adults older than 40 years. However, anyone can have sleep apnea, regardless of age.
Respiratory Medicine Volume 100, Issue 7 , July 2006, Pages 1277-1281
In 20 COPD patients (FEV165% predicted, IC<80% predicted), we evaluated changes in the degree of pulmonary hyperinflation after acute administration of tiotropium or budesonide/formoterol . The study consisted of a screening visit and two study days separated by at least one week. Functional parameters were measured before and 30, and 120 min after inhalation of single study drug.
Respiratory Medicine Volume 100, Issue 7 , July 2006, Pages 1216-1225
We have examined the role of age on the continuous positive airway pressure (CPAP) levels required to treat two groups of elderly (n=70) and young (n=70) sleep apneic patients, matched for disease severity (apnea/hypopnea index), body mass index and neck circumference. Elderly patients required lower CPAP levels compared to young [mean (sd): 6.9(1.9) cm H2O and 9.4(3.5) cm H2O, respectively; P<0.0001].
Respiratory Medicine Volume 100, Issue 7 , July 2006, Pages 1254-1261
There is no agreed definition of difficult asthma or what investigations should be available to investigate these patients. Patients with difficult asthma remain symptomatic on high levels of treatment and are high users of medical resources.
Respiratory Medicine Volume 100, Issue 7 , July 2006, Pages 1262-1269
Non-invasive ventilation (NIV) is widely used for acute and chronic respiratory failure. If arterial blood gas tensions do not improve, the level of support can be increased. However, there may be a limit above which increasing ventilatory support leads only to greater interface leak with no improvement in ventilation. The aim of this study was to establish whether there is such a limit.
Journal of Allergy and Clinical Immunology olume 117, Issue 6 , June 2006, Pages 1272-1276
Fractional exhaled nitric oxide (FENO) is a sensitive marker of eosinophilic airway inflammation in asthma. Available methods have restricted measurements to the clinic, giving only a snapshot of the disease, which by nature is highly variable.
A salmeterol/fluticasone combination (SFC) surpassed a formoterol/budesonide combination (FBC) in reducing the rate of moderate-to-severe exacerbations in patients with persistent asthma, according to a study published by the journal Respiratory Medicine.
A meta-analysis of 19 randomized, controlled clinical studies that lasted at least 3 months indicates that long-acting beta-agonists (LABAs) more than double the rates at which asthma patients may become hospitalized.
Hospital-acquired pneumonia (HAP) has been reported as the second most common hospital-acquired infection in the United States, with an incidence of five to 15 cases per 1,000 hospital admissions.1-3 HAP accounts for approximately 15% of all hospital-related infections and may increase a patient's length of hospitalization by four to nine days.1
Bronchopulmonary dysplasia in premature infants is associated with prolonged hospitalization, as well as abnormal pulmonary and neurodevelopmental outcome. In animal models, inhaled nitric oxide improves both gas exchange and lung structural development, but the use of this therapy in infants at risk for bronchopulmonary dysplasia is controversial.
Annals of Allergy, Asthma and Immunology, Volume 97, Supplement 1, July 2006, pp. 25-30(6)
The National Cooperative Inner-City Asthma Study (NCICAS) tested a model of asthma management in which a master's degree-prepared social worker functioned as an asthma counselor. The NCICAS resulted in decreased symptom days and a trend toward fewer emergency department (ED) visits and hospital admissions in the intervention group compared with the control group.
Stenting is an established palliative procedure for critical tumor obstruction of the airway. However, it is available in few tertiary referral centers. Occasionally, emergency insertion of a tracheal stent is indicated for impending asphyxia. A 60-year-old man with critical tumor stenosis of lower trachea presenting at a time when a dedicated airway stent was unavailable. A reinforced endotracheal tube passed through a tracheostomy functioned as an interval tracheal stent till it was replaced by a dedicated self-expanding stent. If a dedicated stent is not immediately available, a reinforced endotracheal tube may be inserted as an interval stent in the occasional patient presenting with life-threatening tumor stenosis of trachea.
Value in Health, Volume 9, Number 4, July/August 2006, pp. 227-235(9)
To explore the cost-effectiveness of fluticasone propionate (FP) for the treatment of chronic obstructive pulmonary disease (COPD), we estimated costs and quality-adjusted life-years (QALYs) over 3?years, based on an economic appraisal of a previously reported clinical trial (Inhaled Steroids in Obstructive Lung Disease in Europe [ISOLDE]).
Mitomycin C is a potent fibroblast inhibitor that has been used with some success when applied topically to inhibit the vigorous granulation response noted after airway injury in animal models and pediatric patients. We describe, what we believe to be the first 2 cases of patients treated adjunctively with topical Mitomycin C for severe, recurrent tracheal stenosis as a consequence of prolonged intubation. Our objective was to confirm the results of these findings and to expand the potential indications of this therapy in adults.
The aim of this study was to evaluate whether fluticasone propionate (FP) is effective as well as prednisone (P) in reducing sputum eosinophilia and in improving airway obstruction due to asthma exacerbations not requiring hospitalization.
Roflumilast is an oral, once-daily phosphodiesterase 4 (PDE4) inhibitor with anti-inflammatory activity. We compared the anti-inflammatory effects of roflumilast with those of PDE4 inhibitors rolipram, piclamilast, and cilomilast in ovalbumin (OVA)-sensitized and challenged Brown-Norway rats.
Journal of Allergy and Clinical Immunology Volume 117, Issue 6 , June 2006, Pages 1237-1243
Theophylline has been relegated to a second- or even third-line therapy in the treatment of asthma and chronic obstructive pulmonary disease
(COPD), behind glucocorticosteroids and ß2-agonists, although recent findings have suggested that theophylline possesses anti-inflammatory and immunomodulatory effects in addition to its well-recognized effects as a bronchodilator.
Journal of Allergy and Clinical Immunology Volume 117, Issue 6 , June 2006, Pages 1244-1248
Methacholine tests are widely used as a diagnostic aid for asthma. Their strength has been reputed to be the high sensitivity and very infrequent occurrence of false-negative test results (ie, high negative predictive value).
American Journal of Respiratory and Critical Care Medicine Vol 174. pp. 245-253
Bronchoconstriction in asthma leads to heterogeneous ventilation and the formation of large and contiguous ventilation defects in the lungs. However, the regional adaptations of pulmonary perfusion () to such ventilation defects have not been well studied.
To assess the value of the diaphragmatic response to transcranial magnetic stimulation (TMS) in predicting the recovery of ventilatory activity after CNS lesions responsible for central respiratory paralysis.
PEDIATRICS Vol. 118 No. 1 July 2006, pp. e202-e204
Colorimetric carbon dioxide detectors are useful indicators of proper endotracheal tube placement. We have found that they also are helpful during bag and mask ventilation as an indicator of a patent airway. In this report, we describe our experience with these devices for use during preintubation airway stabilization as observed during videotaped performances from a prospective, randomized trial of intubation premedication.
Preclinical studies have revealed that the endogenous nitric oxide synthase inhibitor, asymmetric dimethylarginine (ADMA), increases vascular tone in cerebral blood vessels. Marked elevations of ADMA blood levels were found in patients with diseases characterized by decreased cerebral perfusion, such as ischemic stroke. Arterial stiffness is an independent predictor of stroke and other adverse cardiovascular events. The aim of this study was to investigate the influence of a systemic subpressor dose of ADMA on arterial stiffness and cerebral perfusion in humans.
American Journal of Kidney Diseases August 2006 Volume 48 Number 2
Disorders of sleep behavior and sleep-related breathing disorders are common in hemodialysis patients. Most such evidence is based on studies involving small numbers of patients. Methods: We undertook a large multicenter analysis of sleep behavior in more than 700 Taiwanese patients on maintenance hemodialysis therapy for 6 months to 20-plus years by using self-administered questionnaires: the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Berlin Questionnaire for risk for sleep apnea, validated for the general population. Patients also completed a questionnaire to assess symptoms related to restless legs and periodic limb movements (PLMs).
American Journal of Respiratory and Critical Care Medicine Vol 174. pp. 339-343, (2006)
Interferon- (IFN-) is of central interest in the study of tuberculosis. A number of single-gene mutations have been identified in the IFN- signaling pathway that predispose to severe mycobacterial disease, but the relevance of polymorphism within these genes to the common phenotype of tuberculosis remains unclear.
Interstitial lung disease (ILD) frequently complicates connective tissue diseases (CTDs). Glucocorticoids and immunomodulatory agents are regarded as mainstays of therapy for CTD-related ILD; however, apart from those studies that have evaluated certain medications for patients with scleroderma, few studies have been performed. In this study, our objectives were to examine the safety and tolerability of mycophenolate mofetil (MMF) and to determine its impact on lung function in patients with CTD-ILD.
Development of distant metastases is one of the primary characteristics of malignant tumours. During the last decades, lung metastasectomy has been progressively accepted as a therapeutic option in oncology patients. The present paper aims to evaluate the long-term results and factors influencing prognosis in patients submitted to lung resection for metastases from extrapulmonary epithelial tumours.
This review will focus on the role of viruses as causes of asthma exacerbations. The article will briefly review the current literature supporting this view, with a special focus on human rhinovirus (RV), the main virus associated with exacerbations of asthma.
Ageing is associated with important anatomical, physiological and psychosocial changes that may have an impact on the management of obstructive airway diseases (asthma and chronic obstructive pulmonary disease
(COPD)) and on their optimal therapy. Ageing-related modifications might be responsible for a different effectiveness of bronchodilators in the elderly patients as compared to younger subjects. Furthermore, the physiological involution of organs and the frequent
comorbidity, often interfere with pharmacokinetics of bronchodilator drugs used in asthma and
COPD. This review will focus on the use of bronchodilators in the elderly, with particular attention to the achievable goals and to rationale, utility and pitfalls in using the inhalation therapy in this age group. ß2-agonists, anticholinergics and methylxanthines will be discussed and their side effects in the elderly will be considered.
Radiofrequency ablation (RFA) is an emerging therapy that is increasingly being used for the treatment of many different types of tumors. RFA uses percutaneously placed image-guided probes to destroy tissues through localized heating. Injury to adjacent tissues with significant morbidity during RFA has been reported in the literature. We discuss our anesthetic management of patients undergoing RFA of lung tumors. Lung isolation, one-lung ventilation, and nondependent lung continuous positive airway pressure with air can be used to minimize damage to the heart and other important structures.
Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:1712
Transforming growth factor-ß (TGF-ß) superfamily members, TGF-ß and bone morphogenetic proteins
(BMPs), are potent regulatory cytokines with diverse functions on vascular cells. They signal through heteromeric type I and II receptor complexes activating
Smad-dependent and Smad-independent signals, which regulate proliferation, differentiation, and survival.
Portopulmonary hypertension (POPH) is an uncommon but serious pulmonary vascular consequence of portal hypertension. Untreated, POPH results in right heart failure and death, regardless of the severity of portal hypertension.
Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary vascular resistance which leads to right ventricular failure. Serotonin and the serotonin transporter play an important role in animal and human studies of PAH. We therefore hypothesized that PAH patients treated with high-affinity selective serotonin reuptake inhibitors (SSRIs) would have a reduced risk of death compared to PAH patients not treated with SSRIs.
Intimal sarcomas of the pulmonary artery are rare tumors that are often difficult to distinguish from pulmonary thromboembolic disease, complicating accurate diagnosis and timely therapy. We report the case of a gentleman with a primary pulmonary artery sarcoma who presented with a massive pulmonary embolism and complete right ventricular outflow tract obstruction. The patients condition was successfully managed with urgent pulmonary artery thromboendarterectomy, pulmonary valve replacement, and tricuspid valve annuloplasty.
Bronchodilation following deep inspiration is usually impaired in patients with asthma. This might be due to changes in airway mechanics in the presence of inflammation or structural changes within the airways. Although inhaled corticosteroid treatment has been shown to improve airway responses to deep inspiration in patients with asthma, airway inflammation can persist despite inhaled corticosteroid treatment, and thus could still influence the airway mechanics during deep breaths. We hypothesized that oral steroid treatment further optimizes deep inspiration-induced bronchodilation in clinically stable asthmatic patients who are receiving therapy with inhaled corticosteroids.
Annals of Allergy, Asthma and Immunology, Volume 97, Number 1, July 2006, pp. 34-38(5)
Pressurized metered-dose inhalers (pMDIs) are the cornerstone of asthma treatment. The pMDI is an economic and portable medication delivery system, but the device does not indicate how much medicine remains in the canister once a patient starts using it.
Acute exacerbations of chronic bronchitis (AECB) affect a significant proportion of the adult population worldwide and are associated with a substantial socioeconomic burden. The majority of episodes of AECB are bacterial in aetiology and patients are generally treated empirically with orally administered antibacterial agents. Guidelines for the management of AECB have been developed by a number of national health authorities and international organisations, with the aim of promoting rational selection of antibacterial therapy to minimise the risk of treatment failure and subsequent hospitalisation while containing the development and spread of antibacterial resistance. This paper reviews a number of recently published or updated AECB treatment guidelines, focusing on patient stratification strategies, antibacterial treatment recommendations, and newer antibacterial treatment options, including respiratory fluoroquinolones and the ketolide telithromycin, which have recently been added to a number of national treatment guidelines.
The cardiac pulse is the predominant feature of the pulse oximeter (plethysmographic) waveform. Less obvious is the effect of ventilation on the waveform. There have been efforts to measure the effect of ventilation on the waveform to determine respiratory rate, tidal volume, and blood volume.
Journal of Intensive Care Medicine, Vol. 21, No. 4, 240-245 (2006)
The objective was to describe and review the use of thrombolytic therapy in a patient with an intracranial tumor and massive pulmonary embolism. This is the first reported case of a patient with a known glioblastoma multiforme and massive pulmonary embolism who was successfully treated with alteplase.
Am J Physiol Heart Circ Physiol 291: H904-H913, 2006
Previous investigations have demonstrated a subset of postural tachycardia syndrome (POTS) patients characterized by normal peripheral resistance and blood volume while supine but thoracic hypovolemia and splanchnic blood pooling while upright secondary to splanchnic hyperemia. Such "normal-flow" POTS patients often demonstrate hypocapnia during orthostatic stress.
Enhanced external counterpulsation (EECP) is a non-invasive technique that has been shown to be effective in reducing both angina and myocardial ischemia in patients not responding to medical therapy and without revascularization alternatives. The aim of the present study was to assess the long-term outcome of EECP treatment at a Scandinavian centre, in relieving angina in patients with chronic refractory angina pectoris.
Elevated levels of high-sensitivity C-reactive protein (hsCRP) are associated with higher risk of adverse outcomes in patients at risk for or with established coronary artery disease. Retrospective analyses suggest that this risk may be modified with statin therapy. However, a role for hsCRP in monitoring the success of therapy remains uncertain.
American Heart Journal Volume 152, Issue 1 , July 2006, Pages 149-154
The REPLACE-2 trial demonstrated that bivalirudin with provisional glycoprotein IIb/IIIa (GPIIb/IIIa) inhibition is not inferior to heparin plus GPIIb/IIIa inhibition in patients undergoing percutaneous coronary intervention. The extent to which this applies to patients with acute coronary syndromes (ACS) is unclear. Therefore, we sought to determine if bivalirudin has similar efficacy in ACS patients as compared with stable patients in the REPLACE-2 trial.
Clinical Journal of Sport Medicine. 16(4):348-351, July 2006
This study aimed to compare cardiopulmonary function in patients with a history of swimming-induced pulmonary edema (SIPE) with controls by measuring pulmonary function tests, oxygen consumption with exercise, and the pulmonary arterial pressure response to hypoxemia.
Journal of Infection Volume 53, Issue 1 , July 2006, Pages 21-24
The aim of the study is to assess the usefulness of C polysaccharide and polysaccharide capsular antigen detection by immunochromatography (ICT) and enzyme immunoassay (EIA), respectively, in serum samples for diagnosing pneumococcal pneumonia.
Congenital bronchial atresia (CBA) is an infrequent pulmonary anomaly characterized, in general, by a blindly terminating bronchus, mucoid impaction, and hyperinflation of the peripheral pulmonary parenchyma. We herein report an adult case of lobar bronchial atresia who showed no hyperinflation of the peripheral pulmonary parenchyma.
To describe the frequency and outcome of patients with acute lung injury (ALI) and ARDS who require mechanical ventilation (MV) after lung resection, and to analyze preoperative and perioperative variables associated with mortality.
To find an effective, safe immunosuppressive regimen as an alternative to cyclophosphamide (Cy) for the treatment of clinically evident diffuse scleroderma (dSSc)-associated alveolitis of recent onset.
Current Opinion in Infectious Diseases. 19(4):327-338, August 2006
This review describes the most recent advances in the management and prevention of nosocomial pneumonia. The new ATS guidelines in particular are most likely to affect clinical practice outside the USA.
Journal of Clinical Oncology, Vol 24, No 21 (July 20), 2006: pp. 3340-3346
This study was undertaken to investigate the efficacy and the feasibility of gefitinib for chemotherapy-naïve patients with advanced nonsmall-cell lung cancer
(NSCLC) harboring epidermal growth factor receptor (EGFR) mutations.
We report a rare case of bilateral metachronous bronchial typical carcinoid tumor surgically treated. At the age of 33 years, the patient underwent, in another hospital, a left upper lobectomy for a typical carcinoid tumor. After 4 years, the patient manifested the symptoms of a new central typical carcinoid tumor located at the origin of the middle lobe bronchus and infiltrating the intermedius one. This tumor was first treated by laser therapy, but long-term follow-up evaluation with bronchoscopy revealed a local recurrence of disease. So we performed a middle sleeve lobectomy with radical node dissection.
American Journal of Respiratory and Critical Care Medicine Vol 174. pp. 331-338, (2006)
To compare the impact of moxifloxacin versus ethambutol, both in combination with isoniazid, rifampin, and pyrazinamide, on sputum culture conversion at 2 mo as a measure of the potential sterilizing activity of alternate induction regimens.
The Lancet Volume 368, Issue 9532 , 22 July 2006-28 July 2006, Pages 312-322
Bronchiolitis is a distressing, potentially life-threatening respiratory condition that affects young babies. Around 23% of all infants younger than 1 year are admitted to hospital with bronchiolitis, usually during the seasonal epidemic.
American Journal of Respiratory and Critical Care Medicine Vol 174. pp. 254-259, (2006)
To investigate the relationship between EBC-pH and symptoms suggestive of childhood asthma in an epidemiologic setting and examine its relation to lung function, airway hyperresponsiveness (AHR), and airway inflammation.
American Journal of Respiratory and Critical Care Medicine Vol 174. pp. 312-319, (2006)
On September 11, 2001, the World Trade Center collapse created an enormous urban disaster site with high levels of airborne pollutants. First responders, rescue and recovery workers, and residents have since reported respiratory symptoms and developed pulmonary function abnormalities.
To assess the value of the diaphragmatic response to transcranial magnetic stimulation (TMS) in predicting the recovery of ventilatory activity after CNS lesions responsible for central respiratory paralysis.
American Journal of Surgical Pathology. 30(7):819-827, July 2006
Sex steroid hormone [ie, estrogen (ER), progesterone (PgR), and androgen (AR)] receptors have been identified previously in normal salivary glands and, more variably, in salivary gland and salivary gland-type tumors. No data are available, however, on their expression in pulmonary hamartoma, a benign biphasic tumor consisting of reactive epithelial cells and neoplastic fibromyxoid stroma, cartilage and fat, which shares some morphologic, immunophenotypic, and genotypic features to pleomorphic adenoma of major salivary glands.
Annals of Allergy, Asthma and Immunology, Volume 97, Number 1, July 2006, pp. 105-109(5)
Treatment of rheumatic conditions is limited in patients with asthma owing to concerns of nonsteroidal anti-inflammatory drugs potentially provoking asthma. Cross-sensitivity to all anti-inflammatory drugs that inhibit cyclooxygenase enzymes occurs in these individuals.
Seminars in Pediatric Infectious Diseases Volume 17, Issue 2 , April 2006, Pages 65-71
Pediatric acute respiratory distress syndrome (ARDS) is a severe lung injury caused by pneumonia, sepsis, and trauma. ARDS results from inflammation and pulmonary capillary leak causing major changes in lung architecture and function. It has a low incidence, but its severity and duration cause major morbidity, mortality, and use of resources. Any organism can cause ARDS. Susceptible populations develop the syndrome more often and have worse outcomes. Aggressive diagnosis and intensive treatment are essential to good outcomes in ARDS caused by infection. The prognosis for survival is good, but morbidity after the syndrome is a major burden.
Clinical Nuclear Medicine. 31(8):497-498, August 2006
Abnormal F-18 fluorodeoxyglucose (FDG) accumulation patterns in the lung in patients with cancer having whole-body F-18 FDG-PET/CT scanning for restaging purposes are usually associated with primary lung tumors or lung metastases. Other diagnoses include postobstructive pneumonia and/or atelectasis, granulomatous lung disease, or occult lung infarction. In the latter, enhanced F-18 FDG accumulation topographically matches otherwise proven areas of pulmonary embolism. We document focally enhanced F-18 FDG uptake in the thrombus in the right pulmonary artery in a patient with silent pulmonary embolism. We hypothesize that enhanced F-18 FDG accumulation is attributed to the inflammatory reaction and scavenger cell activity associated with the pathophysiological cascade in pulmonary embolism.