[Platelet activating factor and tumor necrosis factor-alpha in bronchoalveolar lavage fluid of patients with ARDS]

Platelet activating factor (PAF) and tumor necrosis factor alpha (TNF-alpha) were examined in the bronchoalveolar lavage fluid (BALF) of 21 ARDS patients to clarify the role of these factors in ARDS. Neutrophil percentages and albumin concentrations in the BALF of the ARDS group were markedly elevated compared with those in the control group (p < 0.01), showing a significant correlation (r = 0.596, p < 0.01). PAF was detected in 14 of 19 ARDS patients (237.5 +/- 86.0 pg/ml) and TNF-alpha was detected in 7 of 16 ARDS patients (24.9 +/- 13.6 pg/ml), whereas these factors were not detected in control subjects. Neither PAF nor TNF-alpha showed a significant correlation with neutrophil percentage, neutrophil number or albumin concentration. They do not seem to be contributing factors to the prognosis of ARDS patients. However the existence of PAF and TNF-alpha in the BALF of some ARDS patients suggests that they might play a role in the pathogenesis of ARDS.

Therapeutic intervention in a rat model of ARDS: IV. Phosphodiesterase IV inhibition

The following study was performed to determine the effects of phosphodiesterase IV (PDE-IV) inhibition and its attenuation of tumor necrosis factor (TNF alpha) production in a rat model of the Adult Respiratory Distress Syndrome (ARDS). Rats were either unexposed (n = 8), pretreated orally with vehicle prior to intratracheal saline exposure (n = 11), pretreated with vehicle prior to 7 mg/kg intratracheal endotoxin (LPS) administration (n = 22), or pretreated with 5 or 50 mg/kg rolipram prior to LPS exposure (n = 6 and 7, respectively). Blood was sampled 1 and 3 hr post LPS exposure and assayed for plasma TNF alpha concentrations. Twenty-four hours after LPS exposure, blood was sampled again for hematologic measurements. The rats were then anesthetized and exsanguinated. Bronchoalveolar lavage (BAL) was performed after the lung of each rat was removed and weighed. Rolipram pretreatment was protective against LPS-induced mortality and also resulted in reduced plasma TNF alpha concentrations. LPS induced pulmonary edema, as indicated by wet/dry lung weight ratio (W/D) and total BAL protein content (TP) was attenuated by rolipram pretreatment. LPS-induced alveolar hemorrhage was reduced by rolipram pretreatment, but LPS-induced pulmonary neutrophilia was not. The hemoconcentration induced by LPS was reduced by rolipram, as was the LPS-induced thrombocytopenia. However, LPS-induced changes in circulating leukocyte populations were actually exacerbated by rolipram. LPS-induced alterations in renal and hepatic function, indicated by increased blood urea nitrogen (BUN), alanine aminotransferase (ALT), and aspartate aminotransferase (AST), were inhibited by rolipram.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchoalveolar eosinophilic cells in a canine model of asthma: two distinctive populations

In a canine model of asthma, the identity and relationships of two types of cells with eosinophilic granules found in bronchoalveolar lavage (BAL) were investigated. Five female and three male newborn mongrel dogs were sensitized by intraperitoneal injection of 500 micrograms ragweed in 30 mg aluminum hydroxide repeated weekly for 8 weeks and then biweekly until 16 weeks of age. Three female and two male littermate controls received 30 mg aluminum hydroxide. From 4 months of age, dogs received six breaths of wet-nebulized ragweed solution through an endotracheal tube bimonthly. Bronchoalveolar lavage was performed 2 months or more after the last exposure to ragweed and was repeated 5 hours after ragweed inhalation. Dogs studied were 15 to 38 months of age. Eosinophilic cell populations were determined in BAL and peripheral blood; cells were examined by light and electron microscopy. Two eosinophilic cell types were in BAL: an eosinophil and an atypical cell with globule leukocyte characteristics. Specific microgranules, a constant feature of eosinophils, were prominent in the atypical cell and suggest a relationship to the eosinophil granulocyte series for the atypical cell and cells identified by others as globule leukocytes. In ragweed sensitized animals, there were more eosinophilic cells in BAL fluid and more eosinophils in peripheral blood. There was a proportional increase in BAL eosinophils 5 hours after ragweed inhalation and a corresponding decline in peripheral blood eosinophils. There was no increase in numbers of eosinophils in the sensitized animals; eosinophil and atypical cell numbers in littermate controls were unchanged.

Bronchoalveolar lavage in allergic granulomatosis and angiitis

Pulmonary involvement occurs in approximatively half of patients with allergic granulomatosis and angiitis (AGA). We studied bronchoalveolar cells from six patients with histologically proven AGA and compared our results with those obtained from four patients with chronic eosinophilic pneumonia (CEP), nine nonsmoking patients with bronchial asthma and blood eosinophilia, and 10 healthy nonsmokers. Pulmonary infiltrates were present in 5 out of 6 AGA patients. None of these patients was receiving corticosteroids at the time of entry to the study. Pulmonary function tests were normal in two cases, and demonstrated on obstructive ventilatory disorder with hypoxaemia in four cases. Total cell yield did not differ between AGA patients (22.4 +/- 4.9 x 10(4) cells.ml-1), asthmatics (9.6 +/- 1.7 x 10(4) cells.ml-1) and controls (11.3 +/- 1.5 x 10(4) cells.ml-1), whereas it was dramatically increased in patients with CEP (186.4 +/- 26.3 x 10(4) cells.ml-1). All six AGA patients demonstrated an increased percentage of alveolar eosinophils (mean: 31.1 +/- 9.9%; range 6-66%). In two patients evaluation of alveolar eosinophil subpopulations showed a low percentage (27 and 36%) of hypodense cells, when compared to the high levels (> 80%) found in CEP. No significant correlation could be established between bronchoalveolar (BAL) results and clinical data, pulmonary function abnormalities, or biological results. Sequential evaluation of alveolitis in two AGA patients undergoing corticosteroid therapy demonstrated persistent alveolar eosinophilia, despite disappearance of clinical, radiological and biological abnormalities. Our data demonstrate that eosinophils are present in the alveolar spaces of patients with AGA.(ABSTRACT TRUNCATED AT 250 WORDS)

Cellular and cytokine profiles in spontaneous regression phase of hypersensitivity pneumonitis

The phase of spontaneous regression of hypersensitivity pneumonitis was evaluated using a mouse model. C57BL/6 mice were instilled intranasally with 150 micrograms of the thermophilic actinomycete Faeni rectivirgula 3 days a week so as to establish a mouse model of farmer's lungs. It was shown that instillation of mice for a period of more than 6 weeks was associated with a significant decrease in the lung inflammation, suggestive of the so-called spontaneous regression phase seen in this pathology. Indeed, the lung index was seen to decrease after more than 6 weeks of treatment (2.2 after 6 weeks vs. 1.7 at 12 weeks, p < .01). There was also a significant decrease in lung hydroxyproline levels in animals given 12 weeks of treatment (175 micrograms/lung) compared to 6-week-treated animals (212 micrograms/lung, p < .05). Treated mice did not show a significant decrease in the alveolitis after 9 weeks of treatment. Also, there was no evidence that there was a decrease in bronchoalveolar lavage macrophage or T lymphocyte activity in mice given more than 9 weeks of F. rectivirgula treatment, as judged by O2- release and antigen-driven proliferation. Conversely, it was shown that NK cell activity in the lung digest of mice given 9 to 12 weeks of instillation was significantly higher than that seen in mice given 6 weeks of treatment. Analysis of the lung cell cytokine profile seen after ConA mitogenesis showed that after 6 weeks of F. rectivirgula treatments, nonparenchymal cells secreted high levels of tumor necrosis factor alpha (TNF alpha) and granulocyte macrophage colony-stimulating-factor (GM-CSF), whereas similar cells from the lungs of mice given 9-12 weeks of treatment secreted larger amounts of interferon-gamma (IFN gamma) and interleukin-2 (IL-2). Overall, these results suggest that the spontaneous regression phase is associated with changes in NK cell activity and lung cell lymphokine profile.

Activated pulmonary vascular neutrophils as early mediators of endotoxin-induced lung inflammation

Pulmonary vascular sequestration of leukocytes has been reported to increase in some models of lung injury, including that induced by gram-negative bacterial lipopolysaccharide (LPS). Neutrophils recruited to the lung likely participate in LPS-induced lung inflammation and associated injury, but the functional activities of these pulmonary vascular neutrophils have not been directly assessed. In the current study, cells were recovered by pulmonary vascular lavage (PVL) of isolated rat lungs, harvested 2 h after intravenous infusion of LPS (3 mg/kg) or saline in intact rats, at which time LPS-induced neutrophil recruitment to the lung could be appreciated histologically but not by airway lavage. Relative concentrations of leukocytes recovered from the pulmonary vasculature by PVL were compared with those present in circulating blood, normalizing for lavage dilution on the basis of erythrocyte counts. Excess neutrophils, lymphocytes, monocytes, and eosinophils were recovered from the pulmonary vasculature of controls, and LPS infusion increased recovery of neutrophils (most prominently), lymphocytes, and monocytes. Compared with cells recovered from controls, PVL neutrophils from LPS-infused animals were primed for increased zymosan-stimulated superoxide generation, determined by ferricytochrome C reduction, and were more adherent to nylon wool columns. Northern blots of extracted RNA demonstrated that LPS infusion also upregulated interleukin-1 beta (IL-1 beta) mRNA expression in PVL leukocyte samples, but not BAL or circulating blood samples. Ficoll-hypaque separation demonstrated that the LPS-induced IL-1 beta signal in PVL leukocytes was derived primarily from polymorphonuclear rather than mononuclear leukocytes. In conclusion, all circulating leukocyte populations are sequestered in rat lungs, and LPS increases pulmonary vascular sequestration of leukocytes, recruiting most prominently an activated pool of neutrophils that are more adherent, primed for increased oxygen radical production, and expressing increased IL-1 beta message. These findings suggest a more prominent role than previously appreciated for sequestered neutrophils in sepsis-induced lung inflammation.

The effect of antibiotic therapy on recovery of intracellular bacteria from bronchoalveolar lavage in suspected ventilator-associated nosocomial pneumonia

Intracellular bacteria (ICB) within recovered cells (> 7 percent) obtained via bronchoalveolar lavage (BAL) have been described as predictive of subsequent positive quantitative protected specimen brush (PSB) cultures in patients not receiving antibiotics. To determine the effect of prior or current antibiotic therapy on ICB relative to subsequent PSB culture, we prospectively evaluated 49 consecutive episodes of clinically suspected ventilator-associated pneumonia in 36 patients. Three patient groups were defined based on antibiotic administration: group 1 (current antibiotics), n = 31, samples obtained from patients currently receiving antibiotics; group 2 (recent antibiotics), n = 5, samples obtained from patients who received antibiotics > 48 h but < 72 h prior to sampling; and group 3 (no antibiotics), n = 13, samples from patients receiving no previous antibiotics within 7 days prior to sampling. Overall, PSB cultures (> or = 10(3) cfu/ml) were positive in 14 of 49 (29 percent) samples. In group 1, 2 of 31 (6 percent) samples were positive while 5 of 5 (100 percent) samples in group 2, and 7 of 13 (54 percent) in group 3 were positive. The presence or absence of ICB accurately predicted both positive and negative PSB cultures in 43 of 49 episodes. Of 43 correct predictions, 34 were negative predictions (negative ICB, negative PSB culture). The vast majority of these (29) were obtained from group 1, patients currently receiving antibiotics. In contrast, of nine positive predictions (+ICB, +PSB) virtually all (seven) occurred in group 3, patients receiving no antibiotics. In group 3, 13 of 13 PSB cultures were accurately predicted, either positive or negative, by the presence or absence of ICB. Of seven positive PSB cultures in groups 1 and 2, only 2 (28 percent) were accurately predicted by ICB. From both samples, the cultured organism was resistant to all administered antibiotics. These data suggest both prior and current antibiotic therapy reduces recovery of ICB from BAL and reduces predictive accuracy of ICB for subsequent positive PSB cultures. However, negative prediction by ICB for subsequent negative PSB cultures was good. In contrast, ICB obtained from patients not receiving antibiotics are highly predictive of subsequent PSB culture results, both positive and negative. We do not recommend BAL for evaluation of ICB in patients currently receiving antibiotics or with a recent history of antibiotic use.

Soluble interleukin-2 receptor and cellular profiles in bronchoalveolar lavage fluid from patients with bronchial asthma

BACKGROUND

To elucidate the role of T-cell activation in the physiologic changes and cellular infiltrations in the bronchial tree of patients with symptomatic bronchial asthma, we measured the concentration of soluble interleukin-2 receptor (sIL-2R), cellular compositions and IL-2R expression on cells in bronchoalveolar lavage (BAL) fluid. We also measured physiologic parameters, including a provocation concentration of histamine required to reduce the forced expiratory volume in 1 second by 20% of the prechallenge baseline (PC20).

RESULTS

The concentration of sIL-2R and the ratio of IL-2R expression on CD3 positive lymphocytes were significantly higher in BAL fluid from 20 patients with symptomatic bronchial asthma than concentrations in fluid from nine healthy controls (p < 0.01) and six asymptomatic patients with bronchial asthma (p < 0.05). The concentration of sIL-2R correlated with the percentage of IL-2R expression on CD3 positive lymphocytes (rs = 0.709, p < 0.01). There was no difference in sIL-2R concentration of BAL fluid between the healthy control and the patient with asymptomatic bronchial asthma. Among the inflammatory cells recovered in BAL fluid, the percentages of eosinophils showed significant positive correlation with the concentration of sIL-2R in BAL fluid in the patients with bronchial asthma. The concentration of sIL-2R significantly correlated with forced expiratory volume one second, peak expiratory flow rate, and PC20 when observed in all study subjects, but not in the patients with bronchial asthma.

CONCLUSION

We conclude that T-cell activation within the bronchial tree appears to have a role in the infiltration of eosinophils into the bronchial tree, which may lead to enhanced bronchial hyperreactivity in patients with bronchial asthma.

[Comparative study of protected alveolar lavage versus occluded telescopic catheter in patients with suspected pneumonia and under mechanic ventilation]

BACKGROUND

The pneumonias associated to mechanical ventilation present great difficulty in diagnosis and have a high mortality. The invasive diagnostic technique of choice in these patients is bronchial curettage by a double telescopic catheter with distal occlusion (OTC) based on its good sensitivity/specificity relation. Recently, the use of a variant of the classical bronchoalveolar lavage (BRL), bronchoalveolar lavage or protected alveolar lavage (PAL) has appeared in the diagnosis of conventional bacterial pneumonia. This new technique provides good specificity of OTC by its use with "protected" catheters and a high sensitivity due to exploration of a greater area of the lung.

METHODS

Twenty patients receiving mechanical ventilation (MV) suspected of pneumonia in whom 21 fibrobronchoscopies (FB) were performed with OTC and PAL were studied with quantification of the cultures obtained being carried out. The OTC was performed according to the usual technique and PAL by the instillation of 40 ml of saline serum administered through a Combicath type catheter.

RESULTS

OTC and PAL provided diagnostic results which coincided in 8 cases: the same germs were isolated at significant concentrations in six patients and in the two remaining cases direct immunofluorescence for Legionella was positive. PAL was diagnosed in 4 more cases with the diagnosis of viral inclusion bodies being possible in one upon cytologic examination. The count of cells with intracellular bacteria (ICB) was greater than 7% and was always related with positivity in the PAL.

CONCLUSIONS

A greater sensitivity was observed with the protected alveolar lavage technique. Moreover, this technique makes virologic investigation and the counting of cells with intracellular bacteria, which may be a marker of rapid diagnosis of bacterial pneumonia, possible.

Bronchial lavage and bronchoalveolar lavage in allergen-induced single early and dual asthmatic responders

The phenotypic cellular profile of bronchial lavage (BL) and bronchoalveolar lavage (BAL) was studied in 7 single early (SR) and 10 dual asthmatic responders (DR). Lavage was performed, after previously having determined bronchial hyperresponsiveness to histamine and the response to house dust mite (HDM) challenge. The recovered lavage fluid was separated in two fractions, BL and BAL. Total fluid recovery and cell number from the BL and BAL were comparable in both patient groups. Differential cell counting and immunocytochemistry were performed. DR had a significantly higher number of eosinophils and EG2+ cells in BL but not in their BAL. No differences could be found in CD4+, CD8+, and HLA-DR+ cells. A strong correlation was found between eosinophils in the BL+ and EG2+ cells in the BL (r = 0.79, p < 0.001) and between eosinophils in the BL and peripheral blood eosinophils (r = 0.70, p < 0.0025). The number of EG2+ cells and the number of epithelial cells in both BL and BAL showed a correlation (r = 0.55, p < 0.05). Dual responders had a higher total IgE (p < 0.01), and total serum IgE correlated well with the eosinophils in the BL (r = 0.85, p < 0.0001). Our observations demonstrate cellular differences in the lung on mainly a bronchial level between single early and dual asthmatic responders. A bronchial lavage eosinophil and EG2+ cell count and higher blood total IgE level are associated with the tendency to develop a dual asthmatic response.

Studies of phagocytic and killing activities of alveolar macrophages in patients with sarcoidosis

Phagocytosis and killing activities of alveolar macrophages were compared in 17 patients with stage 1 sarcoidosis and 6 healthy controls. The average total cell count of bronchoalveolar lavage fluid from patients with sarcoidosis was 7.8 +/- 7.5 x 10(6) cells; 70.4 +/- 15% of these cells were alveolar macrophages and 25.9 +/- 16.2% lymphocytes. Average total cell count from controls was 8.33 +/- 8.6 x 10(6) cells, with 92.7 +/- 5.9% alveolar macrophages and 6.6 +/- 4.4% lymphocytes. Purified alveolar macrophages were tested in in vitro antibacterial assays using S. aureus as a test microbe. Moderate decreases in the kinetics of staphylococcal ingestion were detected in the sarcoidosis group. The intracellular killing activity of macrophages was much lower in the patients with sarcoid than in control subjects. In a pilot study, intracellular killing activity of macrophages from 1 patient with sarcoidosis was greatly enhanced by 24 hr treatment with transfer factor. In summary, alveolar macrophages from patients with radiographic stage 1 sarcoidosis have decreased bacterial ingestion and intracellular killing activities. These results suggest that macrophages undergo complex functional changes in sarcoidosis that may influence both disease development and host defenses.

Hypersensitivity pneumonitis and airways hyperreactivity induced by occupational exposure to penicillin

A patient with penicillin-induced hyperreactive airways in association with hypersensitivity pneumonitis is described. Patch tests and intradermal tests to penicillin were positive. Bronchoalveolar lavage demonstrated a relative lymphocytosis and mild neutrophilia. Symptoms and physiologic abnormalities of pulmonary function and gas exchange resolved on cessation of exposure to penicillin.

Amiodarone pulmonary toxicity: a multidisciplinary review of current status

Amiodarone, a benzofuran derivative, has proven useful in the control of serious cardiac arrhythmias. We reviewed the English language medical literature to characterize clinical, radiographic, scintigraphic, pathologic, diagnostic, and prognostic data concerning amiodarone pulmonary toxicity. Our review showed that features consistent with amiodarone pulmonary toxicity include exertional dyspnea, fever, and high sedimentation rates, usually in patients taking larger maintenance doses. Positive findings on gallium scan, foamy alveolar macrophages on lung biopsy or bronchoalveolar lavage, and resolution of abnormal chest roentgenogram upon withdrawal of amiodarone and/or institution of corticosteroid therapy support a diagnosis of amiodarone pulmonary toxicity. Conversely, maintenance doses of 400 mg or less daily, normal lung diffusing capacity and bronchoalveolar lavage or lung biopsy specimens without foamy alveolar macrophages are features that make amiodarone pulmonary toxicity unlikely. Amiodarone pulmonary toxicity should be considered in any patient who has new or clinical worsening of respiratory symptoms and/or abnormalities on chest roentgenogram. Congestive heart failure is often present in these patients and must be excluded before a diagnosis of amiodarone pulmonary toxicity can be considered. Amiodarone pulmonary toxicity also needs to be distinguished from pulmonary infection. Therefore, amiodarone pulmonary toxicity remains a clinical diagnosis relying upon a composite of clinical, radiographic, and histopathologic findings.

Detection of pulmonary neoplasms by bronchial washings. Are cell blocks a diagnostic aid?

While cell blocks of bronchial washings are often routinely prepared, their usefulness as adjuncts to the diagnosis of pulmonary neoplasms has not been evaluated. Bronchial washings obtained from 111 patients in whom clinical or radiographic evidence raised the suspicion of a pulmonary neoplasm were reviewed. The smears and cell block preparations were studied independently of each other without knowledge of the original diagnoses. Discrepancies between the smear and cell block diagnoses were noted in 17 cases. Smears detected more neoplasms (52) than cell blocks (43). However, four cell blocks were positive, while the corresponding smears were negative. According to these results, the use of cell blocks increased the diagnostic yield from 52 to 56 cases, for an increase of 9%. Cell blocks will increase the diagnostic yield of bronchial washings, albeit for a small number of patients. However, a positive result will have an obvious influence on patient management and will obviate incremental costs and risks attendant to more invasive diagnostic procedures.

Maloprim-induced pulmonary eosinophilia

A 47-year-old woman developed pulmonary eosinophilia from the use of maloprim as malaria prophylaxis. The diagnosis was confirmed by bronchoalveolar lavage (BAL) and transbronchial lung biopsy. Her condition improved with drug withdrawal and steroid therapy. With the increased use of pyrimethamine and dapsone in the treatment of human immunodeficiency syndrome (HIV) infection, this form of drug allergy may become more common.

Characteristics and mechanisms of nocturnal asthma

Nocturnal worsening of asthma is a very common and significant problem for the vast majority of all asthmatic patients. The involved mechanisms are multiple and interactive. These include circadian alterations in inflammation/mediators, epinephrine, beta 2 receptor function, vagal tone, and body temperature. Other factors may include aspiration, sinusitis, and sleep apnea. Understanding of the mechanisms involved in nocturnal asthma directs the therapeutic approach of these patients.

Temporal association between pulmonary inflammation and antioxidant induction following hyperoxic exposure of the preterm guinea pig

The time course and nature of the pulmonary inflammatory and antioxidant responses, both during and after hyperoxic-induced acute lung injury were studied in the preterm guinea pig. Three-day preterm (65 days gestation) guinea pigs were randomly exposed to either 21% O2 (control) or 95% O2 (hyperoxia) for 72 hours. All pups were then maintained in ambient conditions for up to a further 11 days, during which time lung damage was monitored. In animals exposed to hyperoxia, evidence of acute lung injury and inflammation was characterized by a marked increase in microvascular permeability and elevated numbers of neutrophils in bronchoalveolar lavage fluid. Protein concentration, elastase-like activity and elastase-inhibitory capacity in lavage fluid were at a maximum at the end of the 72 hours hyperoxic exposure. Four days later, all values had returned to control levels. In contrast, increased numbers of neutrophils, macrophages and lymphocytes were recovered in the lavage fluid during this early recovery period. Coinciding with the influx of inflammatory cells, there was a significant increase in glutathione peroxidase, manganese superoxide dismutase and catalase activities in immature lung. Lung copper/zinc superoxide dismutase activity remained unchanged during both experimental periods. The strong temporal relationship between the influx of inflammatory cells to the lung and the induction of pulmonary antioxidant enzyme defences suggests that a common mechanism underlies both responses. These findings have led us to regard inflammation in the hyperoxic-injured immature lung as a beneficial event and not, as previously suggested, as part of the injurious process.

Adenoid cystic carcinoma in a bronchial washing. A case report

A case of adenoid cystic carcinoma of the trachea and bronchi diagnosed on a bronchial washing is reported. This tumor has characteristic cytomorphology best elucidated by May-Grünwald-Giemsa stain.

A mechanism of erythromycin treatment in patients with diffuse panbronchiolitis

Recently, "low-dose and long-term" erythromycin treatment has been reported as effective on diffuse panbronchiolitis (DPB), but its mechanism is still obscure. Patients with DPB were found to have significantly higher percentages of neutrophils in the pre-erythromycin treatment bronchoalveolar lavage fluid (BALF) than healthy nonsmoking volunteers (p < 0.001). They showed a significant reduction in BALF neutrophil percentages after erythromycin treatment (p < 0.01). The neutrophil chemotactic activity (NCA) was significantly elevated in BALF obtained from 19 patients with DPB compared with that from healthy volunteers (p < 0.001). A significant reduction in the NCA was observed in post-erythromycin treatment BALF of 11 patients with DPB (p < 0.001). Additionally, there was a significant correlation between the reduction of NCA and neutrophil percentage in pre- and post-erythromycin treatment BALF (r = 0.726, p < 0.05). Finally, we investigated the effect of erythromycin on the intrapulmonary influx of neutrophils by intratracheal injection of lipopolysaccharide (LPS) and interleukin-8 (IL-8) in mice. The intrapulmonary influx of neutrophils was significantly suppressed (p < 0.001) in mice intraperitoneally injected with erythromycin at 5 mg per animal 2 h before intratracheal injection of LPS (control group: 6.5 +/- 1.6 x 10(5) versus erythromycin-treated group: 1.7 +/- 0.5 x 10(5)), but not 10 h before lung challenge. This inhibition was observed at 6 h after lung challenge and became maximal with 84% suppression at 24 h. Week-long administration of erythromycin did not alter the intrapulmonary influx of neutrophils. The number of neutrophils in the peripheral blood was not affected by erythromycin, indicating that the drug was not toxic.(ABSTRACT TRUNCATED AT 250 WORDS)

Interleukin-2-administration intravenously and intrapleurally in a patient with primary pulmonary adenocarcinoma. Cellular responses in peripheral blood, intrapleural fluid and bronchoalveolar lavage

A case report of a patient who suffered from a rapidly progressive lung adenocarcinoma with malignant pleural effusions, is given. The patient failed to respond on two series of conventional cytotoxic drug therapy (Carboplatin, Etoposide). Interleukin-2 (IL-2) treatment was first started as intrapleural instillations (3.0 million IU per day in 6 days). A clear clinical response was achieved with ceasing of the pleural effusion, and the overall disease became stable. In the peripheral blood, there was an increase of CD4 positive lymphocytes that remained elevated after finishing the installation period. Both in bronchoalveolar lavage (BAL), and in the pleural fluid, there was a marked decrease of cells recovered, possibly due to an enhanced tissue attachment of activated cells. A second analysis with subtyping of lymphocytes in BAL was impossible due to the low cell number. In the pleural fluid, the fractions of CD3 positive cells increased from 20 to 71% while the ratio between CD4 and CD8 remained persistently elevated at 6.1:1. Because of the disappearance of the pleural effusion, the patient was thereafter treated with IL-2 given as a continuous infusion (18 million IU per square-metre during 24 hours for 5 days). Hereby a more pronounced cell response was achieved in the peripheral blood. In contrast to the intrapleural treatment route, not only CD4 positive cells, but also the numbers of natural killer cells (NK) increased. However this treatment was also associated with a much higher degree of side effects. It can be concluded from both intrapleural and intravenous IL-2 therapy, that a clinical and immunological response was achieved.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients

We studied 70 patients with biopsy-proven pulmonary non-Hodgkin's lymphomas without extrathoracic involvement or mediastinal adenopathy to determine the clinical, imaging, and endoscopic features of this condition in a homogeneous series. In low-grade (LG) lymphomas, symptoms were cough, dyspnea, chest pain, hemoptysis. Imaging features consisted of localized alveolar opacities, infiltrative diffuse opacities, atelectasis, and pleural effusions. Inflammatory changes of the mucosa were present in some patients, leading to bronchial stenosis in 7; biopsies showed lymphomatous infiltration in 12. Prognosis of LG lymphomas was excellent, with 93.6 percent survival at five years. High-grade lymphomas differed from LG lymphomas principally by a more aggressive course and a worse survival. Inflammatory changes occurred in seven of nine cases leading to stenosis in two, and biopsies showed lymphomatous involvement in five. The profile of primary pulmonary lymphomas in this study could help clinicians consider this condition and prompt them to evaluate new diagnostic tools.

Pulmonary Hodgkin's disease in HIV-infected patient. Diagnosis by bronchoalveolar lavage

We report herein the pulmonary recurrence of Hodgkin's disease coincidental with a marked decrease in the peripheral blood CD4 lymphocyte count in an HIV-seropositive patient with alveolar consolidation on chest roentgenogram. The diagnosis of lung parenchyma involvement was made by bronchoalveolar lavage cell analysis and illustrates the reliability of Reed-Sternberg cell identification in bronchoalveolar lavage for the diagnosis of pulmonary localization of Hodgkin's disease.