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We report a case of pneumatocele (PC) caused by bronchoscopy and bronchoalveolar lavage performed in a patient with human immunodeficiency virus infection. We speculate that coughing during the bronchoscopy may have contributed to the pathophysiology. A PC is a gas-filled cystic cavity in the lung parenchyma and the mechanism of formation is a 1-way valve that only allows airflow into the cavity.
Catastrophic disasters, particularly a pandemic of influenza, may force difficult allocation decisions when demand for mechanical ventilation greatly exceeds available resources. These situations demand integrated incident management responses on the part of the health care facility and community, including resource management, provider liability protection, community education and information, and health care facility decision-making processes designed to allocate resources as justly as possible.
Activated drotrecogin alfa (human activated protein C, rhAPC), is produced by recombinant DNA technology, and purports to improve clinical outcomes by counteracting the inflammatory and thrombotic consequences of severe sepsis. Controversy exists around the clinical benefits of this drug and an updated economic study that considers this variability is needed.
Uncertainty arises when physiological findings indicate a cardiovascular limitation but the limiting constituents within the cardiovascular system cannot be identified.
Journal of Trauma-Injury Infection & Critical Care. 62(6):1432-1435, June 2007
A higher body mass index (BMI) is associated with hypoxia, hypercarbia, and reduced functional residual capacity. The current study evaluates the association between BMI and the need for mechanical ventilation (MV) among patients who have sustained chest trauma.
Polysomnography findings between matched groups with obstructive sleep apnea (OSA) and OSA plus obesity-hypoventilation syndrome (OHS) before and after continuous positive airway pressure (CPAP), particularly in the extremely severe obese (body mass index [BMI] 50 kg/m2), are unclear.
The presentation of acute eosinophilic pneumonia (AEP) closely resembles that of acute lung injury (ALI)/ARDS, including its idiopathic form, acute interstitial pneumonia (AIP). AEP usually lacks peripheral eosinophilia at the acute phase; therefore, the establishment of serum biomarkers for AEP would be clinically useful.
Natural herbal medicine (NHM) has been used to control infectious diseases for thousands of years. In view of the possible beneficial effect of NHM on SARS, we conducted this study to examine whether NHM is of any benefit as a supplementary treatment of SARS or SARS-like infectious disease.
Patients with chronic obstructive pulmonary disease (COPD) often suffer from exacerbations caused by infections of the bronchial tract. Objective: What effects do hydrotherapeutic applications according to Kneipp have on lung function, blood gases, immune system and quality of life of patients with COPD?
Patients with rheumatoid arthritis (RA) have an increased risk of infection as a result of alterations in immune regulation, debility, and comorbid illnesses. TNF-agr is of central importance in the pathophysiological responses to infection and inflammation, and plays a crucial role in host defence. Pneumocystis carinii is an opportunistic pathogen that commonly affects individuals with inadequate T-cell mediated immune response. Patients with acquired immune deficiency, as well as those receiving immunosuppressive drugs for various conditions have an increased risk of P. carinii pneumonia (PCP).
Journal of Asthma, Volume 44, Issue 5 June 2007 , pages 383 - 384
Nickel sulphate frequently causes allergic contact dermatitis; less known effects are nasal inflammation (rhinitis) and bronchial asthma. In this study, we aimed to find if there is a relationship between asthma and nickel sensitivity. Asthmatic patient, non-asthmatic atopic, and healthy control groups were patch tested with nickel sulphate. Nickel sensitivity was more prevalent in the asthmatic patient group compared to the non-asthmatic atopic and healthy control groups.
Journal of Asthma, Volume 44, Issue 5 June 2007 , pages 385 - 390
Specific concerns from 706 parents regarding their children's (M age = 8.0, SD = 3.9) use of daily asthma medications were systematically identified and organized.
In the main analysis of the Canadian Continuous Positive Airway Pressure (CPAP) for Patients with Central Sleep Apnea (CSA) and Heart Failure Trial (CANPAP), CPAP had no effect on heart transplant-free survival; however, CPAP only reduced the mean apnea-hypopnea index to 19 events per hour of sleep, which remained above the trial inclusion threshold of 15. This stratified analysis of CANPAP tested the hypothesis that suppression of CSA below this threshold by CPAP would improve left ventricular ejection fraction and heart transplant-free survival.
Methacholine challenge testing (MCT), also sometimes described as bronchoprovocation testing, is widely performed for both research and diagnostic purposes. MCT is clinically useful when the patient presents with a history of symptoms suggesting asthma, but spirometry findings are normal.
American Journal of Critical Care. 2007;16: 371-377
To develop a reliable and valid questionnaire for evaluating critical care
nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia.
Journal of Asthma, Volume 44, Issue 5 June 2007 , pages 371 - 375
The European Community Respiratory Health Survey (ECRHS) questionnaire was planned to answer questions about the distribution of asthma. Our objective was to determine the cultural equivalence of the ECRHS into the Brazilian-Portuguese language.
Canadian Journal of Infectious Diseases May / June 2007, Volume 18, Number 3: 189-192
Antibiotics are widely believed to be overprescribed for pediatric respiratory infections, yet there are few data available on the effect of a sudden decrease in antibiotic availability on pediatric infectious disease.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 70-77, (2007)
Hard metal lung disease is caused by exposure to hard metal, a synthetic compound that combines tungsten carbide with cobalt as well as a number of other metals. Interstitial lung disease caused by hard metal is uniquely characterized by giant cell interstitial pneumonia. The pathogenesis of hard metal lung disease is unclear.
Journal of the Medical Association of Thailand Vol90 No. 6 1193 7078
There was an outbreak of botulism in a district in Nan Province in upper northern Thailand. The outbreak occurred after the villagers took bamboo shoots preserved in a sealed bucket under anaerobic conditions (home-canned bamboo shoots). There were 209 people at risk, of whom 119 (56.9%) were hospitalized. Among the 119 cases, 42 (35.3%) needed ventilators. Of the 42 cases, 25 (59.5%) were transferred to another hospital.
Brucellosis represents a rare cause of neonatal infection. In this article we report a very unusual case of congenital infection due to Brucella melitensis in a term neonate presenting after birth with severe respiratory distress and radiological manifestations (lobar consolidation and diffuse interstitial infiltrations) compatible with pulmonary involvement.
Limited information on antibiotic resistance of Streptococcus pneumoniae (SP) exists for patients discharged from emergency departments with community-acquired pneumonia.
Canadian Journal of Infectious Diseases May / June 2007, Volume 18, Number 3: 181-188
While Staphylococcus aureus is an uncommon but serious cause of traditional community-acquired pneumonia (CAP), it is a predominant cause of nosocomial pneumonia in addition to the unique clinical entity of health care-associated pneumonia (HCAP). A cohort of bacteremic S aureus pneumonia cases was reviewed to determine the role of HCAP among the cohort, and to assess for differences between CAP and HCAP.
The purpose of this study was to evaluate the outcome of patients undergoing repeated resection of pulmonary metastases from colorectal cancer and specify factors promising long-term survival.
Journal of Asthma, Volume 44, Issue 5 June 2007 , pages 377 - 381
The objective of this study was to evaluate the relationship between food allergy and asthma morbidity in adults. Methods. We interviewed a cohort of persistent asthmatics from an inner-city clinic. Allergies to food were assessed by patient report of convincing symptoms of acute allergic reactions.
Bronchiolocentric fibrosis is essentially represented by the pathological pattern of constrictive fibrotic bronchiolitis obliterans. The corresponding clinical condition (obliterative bronchiolitis) is characterised by dyspnoea, airflow obstruction at lung function testing and air trapping with characteristic mosaic features on expiratory high resolution CT scans.
Although pulmonary endarterectomy (PEA) is potentially curative in chronic thromboembolic pulmonary hypertension (CTEPH), some patients have distally distributed disease that is not amenable to surgery. The aetiology and characteristics of this patient group are currently not well understood.
A 20-year-old man was referred for intermittent high fever, night sweat and loss of body weight for 6 months associated with progressive exertional dyspnoea which developed 4 weeks before admission. The patient was unresponsive to antibiotics and 14 day pre-emptive antituberculous chemotherapy with rifampicin, isoniazid, ethambutol and pyrazinamide. His temperature was 39.8°C, heart rate 96 beats/min, blood pressure 110/70 mm Hg, breath rate 22/min with decreased breath sounds in the left upper thorax without cyanosis, clubbing and hepatosplenomegaly.
A 69-year-old male non-smoker with a history of atopic asthma of >30 years had recently been diagnosed with pulmonary emphysema (chronic obstructive pulmonary disease, COPD) because of exertional dyspnoea and chronic airflow limitation without bronchodilator responsiveness.
Inhaled asbestos fibres can cause inflammation and fibrosis in the lungs called asbestosis. However, there are no non-invasive means to assess and follow the severity of the inflammation. Exhaled nitric oxide (NO) measured at multiple exhalation flow rates can be used to assess the alveolar NO concentration and bronchial NO flux, which reflect inflammation in the lung parenchyma and airways, respectively.
It is suggested that the inverse relationship between allergic disease and family size reflects reduced exposure to early life infections, and that antibiotic treatment in childhood diminishes any protective effect of such infection.
The hypothesis that ventilation of emphysematous lungs would be enhanced by communication with the parenchyma through holes in the pleural surface was tested.
Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease associated with significant systemic consequences. Recognition of the systemic manifestations has stimulated interest in identifying circulating biomarkers in these patients. A systematic analysis was undertaken of multiple protein analytes in the serum of well characterised patients with COPD and matched controls using novel protein microarray platform (PMP) technology.
The use of administrative databases to perform epidemiological studies in asthma has increased in recent years. The absence of clinical parameters to measure the level of asthma severity and control is a major limitation of database studies. A study was undertaken to develop and validate two database indexes to measure the control and severity of asthma.
The alveolar compartment is a procoagulant antifibrinolytic environment in acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). A study was undertaken to test the hypothesis that the alveolar epithelium can initiate intra-alveolar coagulation by expressing active tissue factor (TF).
MHC class I-restricted CD8+ cytotoxic T lymphocytes (CTL) are thought to play a major role in clearing virus and promoting recovery from influenza infection and disease. This has been demonstrated for clearance of influenza virus from the lungs of infected mice. However, human influenza infection is primarily a respiratory mucosal infection involving the nasopharynx and tracheobronchial tree. The role of CD8+ CTL directed toward the influenza nucleoprotein (NP) in defense against influenza virus infection at the respiratory mucosa was evaluated in two separate adoptive transfer experiments.
Clinical Journal of Pain. 23(6):497-505, July/August 2007
Use of a valid behavioral measure for pain is highly recommended for critically ill, uncommunicative adults. The aim of this study was to validate the English version of the Critical-Care Pain Observation Tool (CPOT) and physiologic indicators [mean arterial pressure, heart rate, respiratory rate, and transcutaneous oxygen saturation (SpO2)] in critically ill ventilated adults.
We described the characteristics of bronchoalveolar inflammatory cells and their correlation with lung injury in patients with Pneumocystis jiroveci pneumonia.We reviewed all cases of patients with Pneumocystis jiroveci pneumonia in newly diagnosed HIV infected patients admitted to a large metropolitan referral hospital during June 2003 to December 2004. Nine patients (5M, 4F) with Pneumocystis jiroveci pneumonia diagnosed with bronchoscopy and cytological examination of bronchoalveolar lavage (BAL) were identified.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 90-95, (2007)
Hypersensitivity pneumonitis (HP) is a lymphocytic alveolitis provoked by exposure to a variety of antigens. However, the disease occurs in only a subset of exposed individuals, suggesting that additional factors may be involved. Microchimerism has been implicated in the pathogenesis of autoimmune diseases, especially in those showing increased incidence after childbearing age.
n a large, nested cohort study published in the American Journal of Respiratory and Critical Care Medicine, the use of inhaled corticosteroids (ICSs) at doses 1,200 mcg/d was associated with a 61% reduction in the risk of developing lung cancer in patients with chronic obstructive pulmonary disease (COPD).
The objectives of this study were to characterize the appearance of normal, dysplastic, and frankly malignant airway lesion appearance under narrow-band imaging (NBI), and to determine if NBI, when used in conjunction with white light (WL) bronchoscopy, could improve detection of dysplasia and malignancy.
Reduced glutathione or simply glutathione (-glutamylcysteinylglycine; GSH) is found in the cytosol of most cells of the body. GSH in the epithelial lining fluid (ELF) of the lower respiratory tract is thought to be the first line of defense against oxidative stress. Inhalation (nebulized or aerosolized) is the only known method that increases GSH's levels in the ELF.
Pediatric Emergency Care. 23(6):362-367, June 2007
Monthly palivizumab injections from November to March decrease risk of respiratory syncytial virus (RSV)-related hospitalization during RSV season in high-risk infants born less than 35 weeks of gestation. Our objective was to investigate compliance with the American Academy of Pediatrics (AAP) recommendations for palivizumab prophylaxis among children who present to the emergency department (ED) with bronchiolitis.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 6-9, (2007)
Epidemiological and observational studies suggest that sleep-disordered breathing is associated with the subsequent development of hypertension and ultimately with cardiovascular consequences. It may therefore be assumed that continuous positive airway pressure (CPAP) not only avoids sleep-related symptoms but could also mitigate cardiovascular consequences.
The latest edition of The International Classification of Sleep Disorders: Diagnostic and Coding Manual subsumes a broad range of disorders under the heading "Sleep Related Hypoventilation/Hypoxemic Syndromes." Some are quite common, such as COPD with worsening gas exchange during sleep; while some are exceedingly rare, such as congenital central hypoventilation syndrome.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 36-41, (2007)
Endobronchial ultrasound (EBUS) and electromagnetic navigation bronchoscopy (ENB) have increased the diagnostic yield of bronchoscopic diagnosis of peripheral lung lesions. However, the role of combining these modalities to overcome each individual technique's limitations and, consequently, to further increase the diagnostic yield remains untested.
The speaking valve is one of the options for oral communication for tracheostomized patients, especially in ICUs. It is a one-way device that is placed onto the tracheotomy tube. Its fine membrane opens during inspiration, allowing air to enter the tracheotomy tube, and closes during expiration, so that air is directed to trachea and vocal folds producing a voice.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 42-48, (2007)
Computed tomography (CT) scanning of the lung may reduce phenotypic heterogeneity in defining subjects with chronic obstructive pulmonary disease (COPD), and allow identification of genetic determinants of emphysema severity and distribution.
Pediatrics International, Volume 49, Number 4, August 2007 , pp. 479-484(6)
Recent studies of chronic lung disease (CLD) of newborns emphasize the contribution of antenatal infection. However, the association of Ureaplasma urealyticum infection and CLD has been controversial. The purpose of the present paper was to determine whether U. urealyticum is associated with chorioamnionitis (CAM) and a certain type of CLD.
Kidney and Blood Pressure Research 2007;30:248-252
Numerous uremic patients on hemodialysis have pulmonary hypertension attributable to the presence of arteriovenous fistulas, vascular calcification, and endothelial dysfunction due to alterations in the balance between vasoconstrictive and vasodilatory substances.
The measurement of fractional exhaled nitric oxide (FENO) is used as a marker of airway inflammation. The aim of this study was to establish reference values of FENO for adults.
Clinical Journal of Pain. 23(6):497-505, July/August 2007
Use of a valid behavioral measure for pain is highly recommended for critically ill, uncommunicative adults. The aim of this study was to validate the English version of the Critical-Care Pain Observation Tool (CPOT) and physiologic indicators [mean arterial pressure, heart rate, respiratory rate, and transcutaneous oxygen saturation (SpO2)] in critically ill ventilated adults.
We described the characteristics of bronchoalveolar inflammatory cells and their correlation with lung injury in patients with Pneumocystis jiroveci pneumonia.We reviewed all cases of patients with Pneumocystis jiroveci pneumonia in newly diagnosed HIV infected patients admitted to a large metropolitan referral hospital during June 2003 to December 2004. Nine patients (5M, 4F) with Pneumocystis jiroveci pneumonia diagnosed with bronchoscopy and cytological examination of bronchoalveolar lavage (BAL) were identified.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 90-95, (2007)
Hypersensitivity pneumonitis (HP) is a lymphocytic alveolitis provoked by exposure to a variety of antigens. However, the disease occurs in only a subset of exposed individuals, suggesting that additional factors may be involved. Microchimerism has been implicated in the pathogenesis of autoimmune diseases, especially in those showing increased incidence after childbearing age.
n a large, nested cohort study published in the American Journal of Respiratory and Critical Care Medicine, the use of inhaled corticosteroids (ICSs) at doses 1,200 mcg/d was associated with a 61% reduction in the risk of developing lung cancer in patients with chronic obstructive pulmonary disease (COPD).
The objectives of this study were to characterize the appearance of normal, dysplastic, and frankly malignant airway lesion appearance under narrow-band imaging (NBI), and to determine if NBI, when used in conjunction with white light (WL) bronchoscopy, could improve detection of dysplasia and malignancy.
Reduced glutathione or simply glutathione (-glutamylcysteinylglycine; GSH) is found in the cytosol of most cells of the body. GSH in the epithelial lining fluid (ELF) of the lower respiratory tract is thought to be the first line of defense against oxidative stress. Inhalation (nebulized or aerosolized) is the only known method that increases GSH's levels in the ELF.
Pediatric Emergency Care. 23(6):362-367, June 2007
Monthly palivizumab injections from November to March decrease risk of respiratory syncytial virus (RSV)-related hospitalization during RSV season in high-risk infants born less than 35 weeks of gestation. Our objective was to investigate compliance with the American Academy of Pediatrics (AAP) recommendations for palivizumab prophylaxis among children who present to the emergency department (ED) with bronchiolitis.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 6-9, (2007)
Epidemiological and observational studies suggest that sleep-disordered breathing is associated with the subsequent development of hypertension and ultimately with cardiovascular consequences. It may therefore be assumed that continuous positive airway pressure (CPAP) not only avoids sleep-related symptoms but could also mitigate cardiovascular consequences.
The latest edition of The International Classification of Sleep Disorders: Diagnostic and Coding Manual subsumes a broad range of disorders under the heading "Sleep Related Hypoventilation/Hypoxemic Syndromes." Some are quite common, such as COPD with worsening gas exchange during sleep; while some are exceedingly rare, such as congenital central hypoventilation syndrome.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 36-41, (2007)
Endobronchial ultrasound (EBUS) and electromagnetic navigation bronchoscopy (ENB) have increased the diagnostic yield of bronchoscopic diagnosis of peripheral lung lesions. However, the role of combining these modalities to overcome each individual technique's limitations and, consequently, to further increase the diagnostic yield remains untested.
The speaking valve is one of the options for oral communication for tracheostomized patients, especially in ICUs. It is a one-way device that is placed onto the tracheotomy tube. Its fine membrane opens during inspiration, allowing air to enter the tracheotomy tube, and closes during expiration, so that air is directed to trachea and vocal folds producing a voice.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 42-48, (2007)
Computed tomography (CT) scanning of the lung may reduce phenotypic heterogeneity in defining subjects with chronic obstructive pulmonary disease (COPD), and allow identification of genetic determinants of emphysema severity and distribution.
Pediatrics International, Volume 49, Number 4, August 2007 , pp. 479-484(6)
Recent studies of chronic lung disease (CLD) of newborns emphasize the contribution of antenatal infection. However, the association of Ureaplasma urealyticum infection and CLD has been controversial. The purpose of the present paper was to determine whether U. urealyticum is associated with chorioamnionitis (CAM) and a certain type of CLD.
Kidney and Blood Pressure Research 2007;30:248-252
Numerous uremic patients on hemodialysis have pulmonary hypertension attributable to the presence of arteriovenous fistulas, vascular calcification, and endothelial dysfunction due to alterations in the balance between vasoconstrictive and vasodilatory substances.
The measurement of fractional exhaled nitric oxide (FENO) is used as a marker of airway inflammation. The aim of this study was to establish reference values of FENO for adults.
B-type natriuretic peptide (NT-proBNP) is considered as an independent prognostic factor in PH. The aim of this study was to evaluate the incidence of PH and its correlation with clinical and laboratory findings, including NT-proBNP.
We prospectively examined 143 clinical samples from 115 patients including both HIV infected (n=53) and HIV uninfected immunocompromized (n=62) patients, with lung infiltrates and with clinical features suggestive of Pneumocystis carinii pneumonia/ PneumoCystis Pneumonia (PcP), using both microscopic techniques as well as PCR assay.
Geriatrics and Gerontology International, Volume 7, Number 2, June 2007 , pp. 174-183(10)
After the release of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in 2001 and update in 2003, its implementation in nine Asian countries was investigated. Questionnaire surveys involving thoraco-pulmonary physicians or internists investigated the awareness and consensus of the GOLD guidelines including the care and management of chronic obstructive pulmonary disease (COPD) patients in Asian.
Journal of Asthma, Volume 44, Issue 3 April 2007 , pages 149 - 161
Clinically, asthma and allergic rhinitis involve separate regions of the respiratory tract while representing a common underlying inflammatory syndrome. Much evidence supports an epidemiologic association between the diseases, paranasal sinus involvement in both conditions, and parallel relationship in severity and treatment outcomes. Pathophysiologic mechanisms, including immunoglobulin E (IgE)- mediated inflammation, are also shared. Blocking IgE with the recombinant humanized monoclonal antibody omalizumab demonstrated clinical efficacy in patients with upper and lower airway diseases.
Annals of Allergy, Asthma and Immunology, Volume 98, Number 5, May 2007 , pp. 447-454(8)
Asthma is the most common chronic disease affecting youth worldwide. The prevalence of asthma has increased at least 3-fold during the past several decades. The reason for this increase remains unknown.
As sarcoidosis is a multisytemic disorder, patients may suffer from various symptoms. The relationship between frequently reported symptoms and quality of life (QOL) has not yet been studied.
We present a case of limited pulmonary cryptococcal infection following exposure to pigeon excreta in a patient with sarcoidosis. The pathogenicity of Cryptococcus neoformans depends on the interplay between the immune status of the host and the virulence of the infecting strain. It can range from asymptomatic lung colonization in the immunocompetent host to rapidly progressive meningitis in immunocompromised patients.
Airway nitric oxide (NO) is low or normal in cystic fibrosis (CF) patients. This may affect bacterial status since NO has antimicrobial properties. Arachidonic acid (AA), which is increased in the serum and airways of CF patients, has been shown to reduce NO levels. The aim of this study was to investigate whether airway NO level correlates with genotype and pancreatic function, and whether low airway NO level is associated with bacterial infection and increased serum AA level in CF patients.
High-frequency oscillatory ventilation (HFOV) is characterized by the rapid delivery of small tidal volumes (VTs) of gas and the application of high mean airway pressures (mPaws). These characteristics make HFOV conceptually attractive as an ideal lung-protective ventilatory mode for the management of ARDS, as the high mPaws prevent cyclical derecruitment of the lung and the small VTs limit alveolar overdistension. In this review, we will summarize the literature describing the use of HFOV in adult patients with ARDS. In addition, we will discuss recent experimental studies of HFOV that have advanced our understanding of its mechanical properties.
Asthma prevalence may be reduced in large families. The hygiene hypothesis suggests that older siblings protect their younger siblings from asthma through a modulating effect on the still-maturing immune system. If the hygiene hypothesis is correct, asthma prevalence should be inversely related to birth order. The objective of this study was to examine the relationship between asthma prevalence, and family size and birth order.
Aging increases vulnerability to obstructive sleep apnea (OSA), but the underlying mechanisms remain unclear. Recent data in awake healthy volunteers show a decrease in the genioglossus negative pressure reflex and anatomic compromise with increasing age, suggesting an age-related predisposition to pharyngeal collapse. However, aging effects on pharyngeal collapsibility have not been studied extensively during sleep. We tested the hypotheses that upper airway closing pressure (PCLOSE) and the increase in pharyngeal resistance during sleep (primary outcomes) as well as measures of arousal threshold (secondary outcomes) increase with age.
Journal of Asthma, Volume 44, Issue 4 May 2007 , pages 253 - 255
Tracheopathia osteoplastica (TPO) is a rare disorder characterized by cartilaginous or bony mucosal nodules in the tracheobronchial tree. Due to most patients being asymptomatic, the majority are diagnosed post-mortem. If symptoms are present, they typically include chronic cough, dyspnea, hemoptysis, hoarseness, and wheezing, with some of these symptoms overlapping with asthma. This case report describes an adult female with chronic cough who was diagnosed with asthma that was refractory to therapy for 8 years.
Journal of Asthma, Volume 44, Issue 3 April 2007 , pages 169 - 175
Research on complementary and alternative medicine use in children with asthma is in its infancy. This study examined the prevalence, types of CAM used and sociodemographic differences in CAM use among children 5-12 years with asthma. 65% of parents reported using CAM. Usage was highest among black, poor, lesser educated parents and children with persistent symptoms. Types of CAM differed by poverty and a trend for differences by race and education emerged. Health care providers who educate themselves on CAM therapies parents use for asthma can then discuss the implications of using these therapies and potentially improve adherence to the prescribed medication regimen.
Journal of Asthma, Volume 44, Issue 3 April 2007 , pages 177 - 181
The present study was conducted to determine whether older adults can learn and retain information on asthma and play a role as community health workers to teach children about asthma. A total of 36 older adults and 28 students in grades K-6 participated. Pre-tests and post-tests were administered to participants. Improvement in older adult scores after training was significant (p = .001), and improvement persisted through the conclusion of teaching sessions (p = 0.001). The increase in lower student scores was significant (p = 0.050). Results suggest that older adults can learn and retain asthma information and schoolchildren can learn asthma-related information taught by older adults.
Journal of Asthma, Volume 44, Issue 4 May 2007 , pages 261 - 266
Asthma control, defined by asthma symptoms and lung function, and asthma medication use, was assessed in 123 adolescent asthmatics. Sputum eosinophilia (ge 2.5% eosinophils) and bronchial hyperresponsiveness (BHR) to hypertonic saline were also measured to assess whether these additional objective parameters might aid in determining asthma control; 54.5% of subjects had adequately controlled asthma; 50.4% of all subjects reported inhaled corticosteroid use in the preceding 12 months; however, only 22.3% reported regular use. Although BHR and median eosinophil numbers were significantly higher in the inadequately controlled asthmatics, BHR and sputum eosinophilia had poor sensitivity for detecting inadequate asthma control.
International Journal of Clinical Practice, Volume 61, Number 7, July 2007 , pp. 1112-1120(9)
Exacerbations of chronic obstructive pulmonary disease (COPD) have serious health consequences for patients and are strongly associated with unscheduled healthcare resource use. This study used a preference-based quality of life measure questionnaire (EQ-5D) to evaluate the impact of exacerbation on health status and utility during a patient's admission to hospital and short-term follow-up.
Pediatric Emergency Care. 23(6):355-361, June 2007
To determine if the addition of intravenous terbutaline provides any clinical benefit to children with acute severe asthma already on continuous high-dose nebulized albuterol.
Increased prevalence of chronic interstitial pneumonia (CIP) is reported in dust-exposed subjects. We investigated the prevalence of CIP in silicosis and mixed-dust pneumoconiosis and sought morphologic differences of CIP between the pneumoconiosis and idiopathic pulmonary fibrosis (IPF).
Gastroesophageal reflux disease (GERD) is common in a variety of chronic respiratory diseases, but little is known about GERD in the setting of COPD. The aims of this study were to determine the prevalence, presentation, and predictors of GERD based on proximal and distal esophageal pH monitoring in patients with severe COPD.
Journal of Sleep Research, Volume 16, Number 2, June 2007 , pp. 217-225(9)
Obstructive sleep apnoea (OSA) is commonly associated with cardiovascular disease and sympathetic activation. However, it is unclear whether this association is independent of obesity and to what extent treatment with nasal continuous positive airway pressure (CPAP) alleviates the vascular inflammation that underpins cardiovascular disease.
Journal of Allergy and Clinical Immunology Volume 119, Issue 6, June 2007, Pages 1323-1328
In this article we discuss 3 hypotheses to attempt to understand why preventive measures thus far studied with the aim of preventing (or delaying) the development of asthma have shown such disappointing results.
Journal of Trauma-Injury Infection & Critical Care. 62(6):1390-1395, June 2007
Operative management of parenchymal lung injury can be complicated by persistent hemorrhage and air leak, which might require resection. Techniques that preserve parenchyma are associated with improved survival. High-intensity focused ultrasound (HIFU) has been demonstrated as a useful method for hemostasis in experimental solid organ injuries. We wished to investigate whether this could be applied to lung injuries.
American Journal of Respiratory Cell and Molecular Biology. Vol. 37, pp. 20-30, 2007
Isoprenylcysteine-O-carboxyl methyltransferase (ICMT) catalyzes methylation of proteins containing a C-terminal CAAX motif. We have previously shown that chemical inhibition of ICMT caused endothelial cell apoptosis, an effect correlated with decreased Ras and RhoA carboxyl methylation and GTPase activities.
The authors aim to report the chest CT findings of a patient with disseminated cysticercosis, emphasising the pulmonary and cardiac features. The main finding consisted of multiple pulmonary, cardiac and chest wall nodules.
American Journal of Respiratory Cell and Molecular Biology. Vol. 37, pp. 121-128, 2007
Apoptosis of lung structural cells is crucial in the process of normal tissue repair. Insufficient apoptosis of lung fibroblasts may contribute to the development of fibrosis. Since the CC chemokine ligand 2 (CCL2) is associated with fibrotic disease and the cytokine IL-6 blocks apoptosis in many cell types, we hypothesized that CCL2 may contribute to the development of lung fibrosis by inducing IL-6, which, in turn, inhibits fibroblast apoptosis.
American Journal of Respiratory Cell and Molecular Biology. Vol. 37, pp. 113-120, 2007
Prostacyclin is an arachidonic acid metabolite that modulates vascular tone within the lung. The current study evaluated the hypothesis that prostacyclin can also modulate tissue remodeling by affecting fibroblast-mediated contraction of extracellular matrix.
American Journal of Respiratory Cell and Molecular Biology. Vol. 37, pp. 97-104, 2007
Exhaled nitric oxide (NO) is altered in numerous diseases including asthma, and is thought broadly to be a noninvasive marker of inflammation. However, the precise source of exhaled NO has yet to be identified, and the interpretation is further hampered by significant inter-subject variation.
Electromagnetic navigation bronchoscopy (ENB) with biopsy under fluoroscopic guidance has enhanced the yield of flexible bronchoscopy in the diagnosis of peripheral lung lesions. However, the accuracy of ENB navigation suggests that the addition of fluoroscopy is redundant.
Sleep-disordered breathing is common in individuals with left ventricular (LV) dysfunction and has been treated with nocturnal positive airway pressure. We investigated whether treatment of central sleep apnea-hypopnea with bilevel positive airway pressure (BPAP) in ambulatory patients with idiopathic dilated cardiomyopathy (IDCM) might improve LV function.
We have reported previously that the sympathetic nervous system is activated in patients with pulmonary arterial hypertension (PAH), and that this is only partly explained by a decrease in arterial oxygenation. Possible causes for increased muscle sympathetic nerve activity (MSNA) in patients with PAH include right atrial distension and decreased cardiac output. Both may be improved by atrial septostomy, but this intervention also further decreases arterial oxygenation. In the present study, we wanted to investigate the effect of atrial septostomy on MSNA in patients with PAH.
Journal of Asthma, Volume 44, Issue 4 May 2007 , pages 325 - 332
This study investigated whether self-reported damage, dust, and odors in homes near the World Trade Center (WTC) after September 11, 2001, were related to increased rates of respiratory symptoms among residents and if multiple sources of exposure were associated with greater health risk.
Journal of Asthma, Volume 44, Issue 4 May 2007 , pages 281 - 283
Asthma is a chronic inflammatory condition. An integral part of the inflammation is angiogenesis (neovascularization). This report describes a patient with rheumatoid arthritis (RA) and moderately severe asthma despite maintenance on inhaled corticosteroids (ics) and intermittent systemic steroids (ss).
ournal of Asthma, Volume 44, Issue 4 May 2007 , pages 311 - 316
The Perceived Stress Scale (PSS) is a widely used measure of stress that has not been validated in asthma patients. The psychometric properties of the PSS were explored using confirmatory factor analysis and item response theory.
International Archives of Allergy and Immunology 2007;144:240-246
The -675 4G/5G plasminogen activator inhibitor-1 (PAI-1) polymorphism is linked with asthma and bronchial hyperreactivity. The aim of this study was to evaluate the effect of allergen challenge on plasma PAI-1 concentration in relation to the -675 4G/5G PAI-1 gene polymorphism in house dust mite-allergic asthma patients (HDM-AAs).
Restrictions on the nonurgent use of hospital services were imposed in March 2003 to control an outbreak of severe acute respiratory syndrome (SARS) in Toronto, Ont. We describe the impact of these restrictions on health care utilization and suggest lessons for future epidemics.
Journal of Hospital Infection Volume 66, Issue 2, June 2007, Pages 142-147
This short-term observational study of infection control practice was performed in the medical emergency outpatient department (EMOPD) of a tertiary-care hospital in India when threatened by an outbreak of severe acute respiratory syndrome (SARS).
Journal of Infection Volume 55, Issue 1, July 2007, Pages 34-40
The global number of non-tuberculous mycobacteria (NTM) pulmonary infections is increasing. Treatment decisions and management are difficult and the prognosis of these infections has been rarely evaluated.
Empyema is an important cause of childhood morbidity with an increasing worldwide incidence. Despite many treatment options being available, there is no general consensus on the optimal management approach due to conflicting reports and lack of properly conducted studies to challenge the personal bias of a physician or surgeon.
Journal of Allergy and Clinical Immunology Volume 119, Issue 6, June 2007, Pages 1332-1336
In some patients, asthma control is improved by combining inhaled corticosteroids with long-acting B2-agonists. However, fluctuating asthma control and exacerbations can still occur.
American Journal of Respiratory Cell and Molecular Biology. Vol. 37, pp. 9-19, 2007
SARS-CoV 3a is a structural protein, mainly localizing to Golgi apparatus and co-localizing with SARS-CoV M in co-transfected cells. Here we observed that transient expression of 3a inhibited cell growth and prevented 5-bromodeoxyuridine incorporation, suggesting that 3a deregulated cell cycle progression. Cell cycle analysis demonstrated that 3a expression was associated with blockage of cell cycle progression at G1 phase in HEK 293, COS-7, and Vero cells 24-60 h after transfection.
Journal of Allergy and Clinical Immunology Volume 119, Issue 6, June 2007, Pages 1337-1348
The term severe refractory asthma (SRA) in adults applies to patients who remain difficult to control despite extensive re-evaluation of diagnosis and management following an observational period of at least 6 months by a specialist. Factors that influence asthma control should be recognized and adequately addressed prior to confirming the diagnosis of SRA.
Respiratory Medicine Volume 101, Issue 7, July 2007, Pages 1369-1375
Bronchial asthma is a chronic inflammatory disease based on an inappropriate stimulation of the immune system, for instance by environmental aeroallergens. It is characterised by bronchial hyperreactivity, reversible airway obstruction and mucus overproduction.
Current Opinion in Pharmacology Volume 7, Issue 3, June 2007, Pages 283-289
Complement is an ancient danger-sensor system of innate immunity, providing first-line defence against pathogens. Concordant with its pro-inflammatory properties, complement contributes to airway inflammation, hyperresponsiveness and mucus production during the effector phase of allergic asthma.
Roflumilast, an oral, once-daily phosphodiesterase 4 inhibitor, is currently in clinical development for the treatment of asthma. Objectives: This pilot study examined the effect of roflumilast on allergen-induced airway hyperresponsiveness (AHR) to histamine challenge and asthmatic response to allergen challenge.
Many patients have problems using the correct inhalation technique when they use their metered-dose inhalers (MDIs). We have investigated whether a training aid (2Tone Trainer [2T]; Canday Medical Ltd; Newmarket, UK) helps to maintain the correct inhaler technique after patients leave the clinic.
Respiratory Medicine Volume 101, Issue 7, July 2007, Pages 1426-1430
Previous data from the literature reported blunted perception of airway obstruction in severe asthmatics with near fatal asthma. Approximately 25% of patients with asthma are current smokers.
Journal of Hospital Infection Volume 66, Issue 2, June 2007, Pages 116-122
The recent increase in hospital-acquired infections (HAIs) has meant that hospital-acquired pneumonia (HAP) has come under the spotlight. HAP is the most common HAI contributing to death and affects about 0.5-1% of all patients admitted to hospital.
Respiratory Medicine Volume 101, Issue 7, July 2007, Pages 1439-1446
Non-thyroidal illness syndrome (NTIS) is frequently detected in chronic, systemic diseases. The objectives of the current study is to assess the alterations of thyroid hormones during exacerbation period, recovery of exacerbation and stable phase of chronic obstructive pulmonary disease (COPD) and correlates of these hormonal alterations.
Respiratory Medicine Volume 101, Issue 7, July 2007, Pages 1376-1382
Deep inspiration (DI) protects against methacholine-induced bronchoconstriction in healthy subjects. We hypothesized that this bronchoprotective effect of DI depends upon the inspiratory flow rate.
Little is known regarding the factors associated with the times for patients’ first physician visit, the first physician suspicion of work-related asthma
(WRA), and final diagnosis after the onset of WRA symptoms. This study examined individual and work-related factors that are associated with longer times to these diagnostic milestones among groups with occupational asthma (OA) and work-exacerbated asthma (WEA).
Several chemoattractants have been measured in exhaled breath condensate (EBC) from patients with COPD. The aim of this study was to compare the eosinophil and neutrophil chemotactic activity contained in EBC from healthy subjects and patients with COPD.
Congestive heart failure (CHF) is a well-recognized risk factor for venous thromboembolism (VTE) and is associated with higher mortality in patients with an acute pulmonary embolism (PE). There are very few data on how acute PE affects the clinical course of patients with heart failure. The purpose of this study was to determine the impact of an acute PE on the short-term prognosis of patients hospitalized for decompensated CHF.
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