Late consequences of respiratory system burns

Burn inhalation has negative effects on pulmonary function and may result in whole airway damage. The consequences of a methane explosion are thermal injury of the respiratory tract, shock wave, and carbon monoxide intoxication. The aim of this study was to determine changes in the pulmonary function tests (PFTs) after six years of follow-up in miners who survived a methane explosion. Two groups were examined: 41 miners who fell victims to a methane explosion and had a documented thermal injury of the respiratory tract and 25 healthy miners who served as controls. Pulmonary function studies were repeated after six months and six years from the time of injury in 33 study subjects and at the same time intervals in 16 control subjects. The study included static and dynamic lung volumes and diffusing capacity for carbon monoxide (DLCO). The mean values of PFTs were within normal ranges in both groups examined six months and six years after the injury. A significant decrease in DLCO was observed in the victims (98.4% vs. 85.4%), but not in the control group, after a six years' observation. The decrease may be one of the reasons for a breathing discomfort emerging in these patients. In the control subjects we observed a significant decrease in FEV1 (96.4% vs. 83.4%)--over a six years' period. This finding is due likely to smoking and heavy pollution of the working environment.

Human cytomegalovirus DNA level in patients with idiopathic pulmonary fibrosis

The objectives of the study were to estimate human cytomegalovirus (HCMV) DNA copy number in broncho-alveolar lavage cells, blood leukocytes, and serum of patients with idiopathic pulmonary fibrosis (IPF). The study groups consisted of 16 patients, newly diagnosed with IPF and never treated, (mean age 40.9 +/-11.0 yr; F/M-7/9) and in 16 adult healthy volunteers (mean age 36.8 +/-6.4 yr; F/M-4/12) used as controls. The HCMV DNA copy number was calculated by a Q-PCR method using TaqMan ABI PRISM 7700. We found that the prevalence of the HCMV DNA positive subjects in the patient group (75%) did not differ significantly from that in the control group (69%). We also found that in both patient and control groups the mean HCMV DNA copy number in BAL cells was significantly higher than that in blood leukocytes (log10=2.7 vs. 1.2 for patients and 2.8 vs. 0.9 for controls, respectively). However, a higher HCMV DNA copy number in blood serum was observed in IPF patients than in controls (log10=3.2 vs. 2.0, respectively). We conclude that the lungs play an important role in the human pathobiology of cytomegalovirus sustenance.

[Fluorescence diagnostics of premalignant and malignant changes in patients with Barrett's esophagus: doubts and hopes]

Increasing incidence of esophageal adenocarcinoma that mostly arises from Barrett's esophagus (BE) has been observed. Therefore sensitive methods for early detection of dysplasias and adenocarcinomas in BE are more and more necessary. Fluorescence endoscopy is an alternative or complementary to standard four-quadrant biopsies technique. The basics of diagnostics application of tissue autofluorescence and exogenous dyes fluorescence such as protoporphyrin IX, induced by 5-aminolevulinic acid are summarized. There are two methods of fluorescence diagnostics of dysplasia in BE: point fluorescence spectroscopy and real-time fluorescence imaging. Fluorescence spectroscopy is sensitive and specific but can be targeted only toward lesions visible in white-light endoscopy. Fluorescence imaging allows to examine large areas for occult foci of dysplasia but selectivity is somewhat limited by the background fluorescence of Barrett's mucosa. Laser induced fluorescent endoscopy (LIFE) images of esophageal dysplasia are presented. Up-to date results of fluorescence spectroscopy and fluorescence imaging of BE are reviewed. These results indicate fluorescence diagnostics promising and clinically useful for detection of early adenocarcinoma and dysplasia in BE.

[Selection of bronchoscope type for removal of foreign bodies from the lower respiratory tract based on personal experience]

32 patients, in whom bronchoscopy was performed due to the removal of foreign body from the lower respiratory tract were described. Age of the patients clinical symptoms and a time lapse between aspiration and removal of foreign body from the lover respiratory tract and localization of foreign body in the particular bronchus were analysed. We conclude, that rigid bronchoscopy is still more useful and safe method of foreign body removing from the lower respiratory tract.

[Effect of asymmetric respiratory exercise therapy on respiratory system function; evaluation using spirometric examination in children with idiopathic scoliosis]

Current work presents the results of spirometric examinations in 124 children aged 5 to 16 years (mean age 12.1 years) suffering from idiopathic scoliosis. Children were treated according to asymmetric respiratory exercises method applied in period of 24 days. Healthy children living in Upper Silesia industrial region were the control group. Examined scoliotic group was characterized by generally mild lung function impairment, although the values of spirometric indexes tended to deplete with time of duration and severity of the scoliosis. Especially the tendency of the forced expiratory volume in first second (FEV1) decrease was apparent, as well as maximal expiratory flows MEF50 and MEF25, in conjunction with Cobb angle increase. Slight but evident increase of forced vital capacity (FVC) and FEV1 was observed as a result of rehabilitation utilizing asymmetric respiratory exercises method.

[Cytokines TNF-alpha and GM-CSF in BAL from two different segments of lungs defined by high resolution computerized tomography (HRCT) in patients with sarcoidosis]

The aim of the study was to evaluate the concentrations of TNF-alpha and GM-CSF in double BAL (2 x 120 ml) from two different lung segments: (s.A) from upper lobe with the most and (s.B) from lower lobe with the least extensive involvement estimated by high resolution computed tomography (HRCT). Examined group consisted of 28 non-smoking sarcoid patients with homogenous, regular distribution of nodular opacities in conventional chest X-ray (14 F, 14M aged 19-54). In examined patients 16 had nonhomogenous distribution (ND) and 12 had regular distribution (RD) of HRCT changes. Eleven healthy volunteers served as controls. In patients with sarcoidosis we observed the significantly higher concentrations (p < 0.01) of TNF-alpha (3.18 pg/ml, 2.64 pg/ml) and GM-CSF (1.01 pg/ml, 0.95 pg/ml) respectively in BAL fluid from s.A and s.B in comparison with BAL from s.Abis and s.Bbis in control group (TNF-alpha: 0.46 pg/ml, 0.47 pg/ml and GM-CSF: 0.28 pg/ml, 0.31 pg/ml respectively). Mean concentration of TNF-alpha in BAL from s.A (3.77 pg/ml) in ND group was significantly higher than in BAL from s.B in RD group (2.91 pg/ml). TNF-alpha in BAL from s.A in active sarcoidosis was higher than in BAL from s.A and s.B in non-active sarcoidosis. Concentrations of TNF-alpha in BAL from both s.A and s.B correlated positively with CD4/CD8 ratio, percentage of lymphocytes, lymphocytes HLA-DR+ and absolute number of CD4 cells and negatively with CD8 cells estimated in BAL from these lung segments. In patients with indications to therapy the level of GM-CSF in BAL from s.A (1.44 pg/ml) was significantly higher (p < 0.05) than in BAL from s.A (0.64 pg/ml) in patients without indications to treatment. We conclude that TNF-alpha and GM-CSF may be involved in sarcoidosis pathogenesis and TNF-alpha may be useful in estimation of sarcoidosis activity.

[Risk factors for airway obstruction in school children with respiratory symptoms assessed in a five year prospective study]

The aim of this prospective study was to assess age-related changes of the respiratory status and to evaluate risk factors for persistent airflow obstruction in symptomatic school children. One hundred fifty children aged 7-12 years (mean age 9.5 yr.) were followed-up. In 1994 parents--administered questionnaire, skin prick tests and three dynamic spirometries in 4-6 week intervals were performed. Airways flow limitation was defined as FEV1%, MEF50 or MEF25 below minimal value. In 1999 questionnaires and spirometry were repeated by the same methods. The response rate was 74.7%. Children's respiratory status generally improved. Frequency of respiratory symptoms and obstructive disturbances (37.5% in 1994 versus 22.3% in 1999) decreased. Significant risk factors for airways flow limitation in 1999 were nocturnal dry cough, doctor diagnosed asthma, female gender and parental smoking. Advanced or persisting airway obstruction during several month in 1994 was valuable to predict lung function impairment in 1999. No relation between skin tests results and persistent airway obstruction was observed.

[Proangiogenic cytokines (bFGF and VEGF) in BALF from two different lung segments examined by high resolution computed tomography (HRCT) in patients with sarcoidosis]

The aim of the study was to evaluate the concentrations of bFGF and VEGF in double BAL (2 x 120 ml) from two different lung segments: (s.A) from upper lobe with the most and (s.B) from lower lobe with the least extensive involvement estimated by high resolution computed tomography (HRCT). Examined group consisted of 28 sarcoid patients with homogeneous, regular distribution of nodular opacities in conventional chest X-ray (14 F, 14 M aged 19-54). Eleven healthy volunteers served as controls. In patients with sarcoidosis we observed the significantly higher levels (p < 0.01) of bFGF (1.79 pg/ml, 1.48 pg/ml) and VEGF (107.5 pg/ml, 109.7 pg/ml) in BAL from s.A and s.B respectively in comparison with BAL from lung segments Abis and Bbis in control group (bFGF: 0.75 pg/ml, 0.47 pg/ml and VEGF: 33.7 pg/ml, 43.9 pg/ml respectively). bFGF in BAL from s.A in active sarcoidosis was higher than in s.A and s.B in non-active sarcoidosis. Concentrations of bFGF in BAL from both s.A and s.B correlated positively with CD4/CD8 ratio and absolute number of lymphocytes, CD4 cells and lymphocytes HLA-DR estimated in BAL from these lung segments. We conclude that bFGF and VEGF may be involved in sarcoidosis pathogenesis and bFGF may be useful in estimation of sarcoidosis activity.

[Chemokine RANTES in bronchoalveolar lavage fluid(BAL)from two different lung segments indicated by high resolution tomography (HRCT) in patients with sarcoidosis]

In 28 non-smoking patients with sarcoidosis (14 males, 14 females aged 19-51) the concentrations of cytokine RANTES were estimated in BAL fluid from two different lung segments: with the most (s.A) and with the least (s.B.) extensive involvement estimated by high resolution computed tomography (HRCT). In examined subjects 12 patients showed homogeneous distribution of HRCT changes (HD) in lung parenchyma and 16 showed nonhomogeneous distribution of HRCT changes (ND) with domination of pathological changes in upper lobes. Eleven healthy volunteers served as controls. In BALF from s.A and sB the significantly higher concentrations of RANTES were observed in comparison with control group (14.4 and 10.9 pg/ml vs 3.6 and 3.4 pg/ml respectively). In group (ND) in BALF from s.A (from upper lobes--the most occupied by HRCT changes) the concentrations of RANTES were significantly higher than in BALF from s.B (from lower lobes with the least involvement estimated by HRCT). RANTES concentrations in BALF from s.A and s.B positively correlated with lymphocytes count, lymphocytes CD3, CD4 and HLA-DR+ and correlated negatively with diffusing capacity in sarcoid patients. Our results suggest the significant role in pathogenesis of sarcoidosis and in alveolitis process enhancement.

[BALF from two different lung segments indicated by high resolution computer tomography (HRCT) in patients with sarcoidosis. III. Correlation between pulmonary function tests and HRCT changes and BAL cell count]

In 28 patients with sarcoidosis patients (14 F, 14 M aged 19-54) lymphocytes subpopulations were estimated in double BAL from two lung segments: with the most (s.A) and with the least (s.B.) extensive involvement estimated by high resolution computed tomography (HRCT). HRCT score for whole lung correlated negatively with DCO (r = 0.46, p < 0.05), D/VA (r = -0.46 p < 0.05), Cstat (r = -0.57, p < 0.05) and Cdyn (r = 0.-057, p < 0.01). HRCT-score for lung segments A and B did not correlate with BAL-cell count and lymphocytes subsets from these segments. The relationship between percentage of lymphocytes HLA-DR in BAL from s.A and d(A-a)O2 (r = 0.38, p < 0.05) and the relationship between absolute number of CD25 in BAL from s.A and DCO (r = -0.38, p < 0.05) were observed. The percentage of lymphocytes in BAL from s.B correlated negatively with D/VA (r = -0.40, p < 0.05) and the percentage of HLA-DR lymphocytes in BAL from s.B. correlated negatively with Cdyn (r = -0.45, p < 0.05). Our results suggests usefulness of HRCT in estimation of sarcoidosis advancement but not in it's activity and indicate the careful interpretation the relationships between BAL results from only one lung segment and pulmonary function parameters.

[BAL from two different lung segments indicated by high resolution computed tomography (HRCT) in patients with sarcoidosis. I. Evaluation of alveolitis homogeneity and estimation of HRCT usefulness in selection of lung region for BAL]

The aim of the study was: 1) to evaluate the homogeneity of alveolitis by estimation of lymphocytes subsets in double BAL (2 x 120 ml) from two different lung segments: with the most (s.A) and with the least (s.B.) extensive involvement estimated by high resolution computed tomography (HRCT) 2) to examine the usefulness of HRCT as a guide method in selection the most reliable lung region for BAL. Examined group consisted of 28 sarcoid patients with homogeneous, regular distribution of nodular opacities in conventional chest X-ray (14 F, 14 M aged 19-54). Twelve patients showed homogeneous distribution of HRCT changes (RD) in lung parenchyma and 16 showed nonhomogeneous distribution of HRCT changes (ND) with domination of pathological changes in upper lobes. Eleven healthy volunteers served as controls. BAL lymphocytes subpopulations (CD3, CD19, NK, CD4, CD8, HLA-DR, CD25,) were estimated by flow-cytometry. Among patients from ND group in BAL from s.A we found the significantly higher (p < 0.01) mean total cell yield, the significantly higher (p < 0.05) mean values of % of lymphocytes (45.2 vs 36.8%) and CD4/CD8 ratio (5.3 vs 4.4) than in BAL from s.B. Also the mean values of absolute number of lymphocytes and lymphocytes CD4, HLA-DR, CD25 in ND group were significantly higher in BAL from s.A than in BAL from s.B. In RD group and in controls no significant differences between BAL findings from s.A and s.B were noticed. Our results suggest that: 1) alveolitis process is not fully homogeneous, it's intensity is greater in upper lobes with most extensive involvement of HRCT changes 2) HRCT can serve as a useful method for selection the most reliable lung region for BAL.

[BAL from two different lung segments indicated by high resolution computed tomography (HRCT) in patients with sarcoidosis. II. The role of T gamma delta lymphocytes (T gamma delta)]

The aim of the study was to evaluate the role of lymphocytes T gd in sarcoidosis by estimation of T gd cells in double BAL (2 x 120 ml) from two different lung segments: with the most (s.A) and with the least (s.B.) extensive involvement evaluated by high resolution computed tomography (HRCT) and in peripheral blood. Examined group consisted of 28 sarcoid patients with homogeneous, regular distribution of nodular opacities in conventional chest X-ray (14 F, 14 M aged 19-54). Twelve patients showed homogeneous distribution of HRCT changes (RD) in lung parenchyma and 16 showed nonhomogeneous distribution of HRCT changes (ND) with domination of pathological changes in upper lobes. Eleven healthy volunteers served as controls. Lymphocytes T gd were estimated by flow-cytometry. In peripheral blood of patients with sarcoidosis the mean value of T gd lymphocytes (4.75%) did not differ from control group (5.3%). In all patients the mean values of T gd percentage in BAL from s.A (1.7 + 1.0%) and in BAL from s.B (2.1 + 1.5%) were significantly lower (p < 0.01) than the mean value in peripheral blood (4.75 + 2.4%) and were significantly lower than mean value of T gd cells in BAL from s.B bis (4.2 + 2.7%). Among subgroups ND and RD we did find any significant differences between values of T gd in BAL form s.A and s.B. Our results suggest minimal role of T gd lymphocytes in sarcoid pathogenesis.

Inter-laboratory comparison of flow-volume curve measurements as quality control procedure in the framework of an international epidemiological study (PEACE project)

The aim of this work was to describe the results of a simple quality control procedure for the flow-volume curve adopted in a multicentre epidemiological study (PEACE). In 14 centres, 8-15 individuals (n = 157) performed forced vital capacity (FVC) manoeuvres following a standard protocol with both the local spirometer/pneumotachograph and a portable spirometer (i.e. the 'reference instrument' for this study). Deviances of measurements were assessed by computing the differences (delta) between the former and the latter, the ratios of such differences on portable spirometer values (delta %) and the coefficients of variation (CV). The portable spirometer yielded lower mean AFVC and deltaFEV1 (forced in 1 sec) than local instruments (except for two and four centres, respectively). In most instances, differences were statistically significant. Absolute mean A%FVC ranged from 4.9-18.2%, while delta%FEV1 ranged from 2.3-18.5%. The Bland and Altman analysis showed a good agreement between the portable and local instruments, except for two centres, where a systematic trend towards higher individual absolute deltaFVC and deltaFEV1 was observed. The overall variability, assessed by CV, was within 6.2% and 5.1% for FVC and FEV1, respectively: it was similar to other quality control studies ranging from 2.0-5.5% for FVC and 2.2-5.8% for FEV1. Our results point out the importance of performing interlaboratory comparisons as a quality control procedure in multicentre epidemiological studies on lung function, and of stimulating manufacturers to extend the accuracy and precision of the instruments.

[Cell count and immunoglobulin level in the bronchoalveolar lavage fluid (BALF) in patients with sarcoidosis]

In 49 patients with pulmonary sarcoidosis BAL differential and T-cell count, determination of IgG, IgA levels in BAL-fluid were performed. A significant increase of lymphocytes, T-cell count and levels of IgG in BAL-fluid in patients with active sarcoidosis was found. Steroid therapy significantly lowered lymphocyte counts and increased the number of macrophages.

[Study of the effect of salbutamol inhalation on the function of small airways in patients with chronic bronchitis without ventilatory disorders using simple spirographic tests]

In 68 males with chronic bronchitis and normal standard spirometric parameters and in 30 healthy males the following were assessed: VC, FEV1, V50 and V75 before and after Salbutamol inhalations. In chronic bronchitis Salbutamol slightly decreased FEV1 values. Significant improvement of V50 and V75 was seen after Salbutamol inhalations in chronic bronchitis. This was observed more promeinently in comparison with the control group. Significant increase of V50 and V75 was seen in 14% of chronic bronchitics. The improvement in pattency of small airways following administration of bronchodilators can be an index for early identification of patients with chronic bronchitis, although this needs to be verified in prospective spirographic studies.