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  • SUMMARY In the present study, a new technique for the detection of expiratory flow limitation (EFL) during experimental artificial ventilation is proposed, based upon a specific analysis of the driving pressure (Pao), the volume (V) and the flow (V΄) signals in eight tracheotomized and intubated rabbits. EFL was provoked by application of negative expiratory pressure or/and intravenous infusion of Histamine. EFL was detected by application of: Additional negative expiratory pressure (ANEP) and b) Forced oscillations. Two equal volume paired points have been chosen, that correspond to 10% and 90% of the expiratory tidal volume. The recorded pressure gradient (ΔP) between these paired points may be considered as totally consumed for the development of the corresponding flow difference (ΔV΄). The comparative evaluation of the ‘differential’ resistance (ΔR=ΔP/ΔV΄) expressed by the index: ΔR90%VTexp- ΔR10%Vtexp x100/ΔR10%VTexp permitted the EFL detection with absolute specificity and sensitivity. The observed high values of the proposed index (mean value: 60.6 ± 9.23), at the presence of EFL, express the significant increase of ΔR90%VTexp. On the contrary, the low values of the index (mean value 4.5 ± 15.26), in the absence of EFL, are related to the relative stability of ΔR during the whole respiratory cycle. The proposed method is simple, noninvasive, it does not require any change of the ventilator settings and is offered for continuous monitoring. Pneumon 1999, 12 (2): 84-92
     
  • SUMMARY p53 and p21WAF-1 expression were examined by immunohistochemistry in neoplastic, preneoplastic and normal bronchial mucosa in 60 patients with lung cancer in order to investigate the role of the corresponding genes in lung carcinogenesis. p53 expression was present in 43% of the tumours, 27.5% of the preneoplastic lesions and in normal mucosa, in 16.7% of the patients. p21WAF-1 expression was present in 60% of the tumours, 47.5% of the preneoplastic lesions and in normal rnucosa, in 63% of the patients. There was a statistical significant trend of p53 - positive tumours to coexist with p53 - positive preneoplastic lesions in the same patient, and patients with p53 - positive tumors or preneoplastic lesions to exhibit also p53 expression in normal mucosa. There was a statistical significant trend of p21WAF-1 positive tumours to coexist with p21WAF-1 positive preneoplastic lesions in the same patient. These results may indicate that abnormalities in p53 and WAF-1 genes are early events in lung carcinogenesis and that p53 expression in non-neoplastic mucosa is an indicator of lung field cancerization and may uncover increased risk of non-neoplastic mucosa to progress into cancer. Pneumon 1999, 12 (2): 93-103
     
  • SUMMARY Adenosine Deaminase Activity (ADA) levels were determined in Bronchoalveolar Lavage Fluid (ΒALF) of 102 patients, aged 24-78 years (63 men,39 women) whο underwent bronchoscopy in order to establish diagnosis for various pulmonary diseases. Fifty patients with active pulmonary Tuberculosis were further divided into three subgroups according to the radiologic extent of lesions: A for the extended disease, B for the less extended disease and C for the limited disease. Fifty two patients with other pulmonary diseases were used as control group for the comparisons with Tuberculosis group: Fourteen with Bronchogenic Carcinoma, 16 with Interstitial Pulmonary Disease (UIP), 10 with Sarcoidosis and 12 with non specific Infections of the lower respiratory tract. ADA levels were measured in ΒALF as well as in blood serum. Cellular subpopulations and percentages as well as CD4/CD8+ ratio were also determined in BALF in 20 patients of the Tuberculosis group. The levels of ADA in BALF of patients with Tuberculosis were significantly higher (p<0,001) compared to the other groups of patients with the exception of patients with Sarcoidosis (p=0,09). ADA values in ΒALF were significantly different in the three subgroups A,B and C (p<0,001), well correlated to the extent of the chest x-ray lesions. Sensitivity and Specificity of ADA in ΒALF for the diagnosis of Tuberculosis were 80% and 78,6% respectively for cut off value of 1,85u/lt, excluding Sarcoidosis patients. Sensitivity and Specificity of ADA in ΒALF were higher in group A compared to B or C. An important increase of Lymphocyte and Neutrophile percentages (20,5 ± 11,6) and (4,2% ± 5,6) respectively as well as an important increase of CD4+/CD8+ ratio (4,9 ± 2,3) were observed in BALF of patients with Tuberculosis. ADA was strongly correlated with CD4+/CD8+ ratio values showing a tendency of almost parallel increase. Our results indicated that ADA determination in ΒALF constitutes a usefull marker in the diagnosis of Tuberculosis especially when radiologic lesions are extended. Also cellular measurements in BALF of patients with Tuberculosis indicated that Adenosine Deaminase plays the role of a marker of the immunological response of the lung infected by Mycobacterium Tuberculosis. Pneumon 1999, 12 (2): 104-116
     
  • SUMMARY Bronchial hyperesponsiveness (BHR) is a characteristic feature of asthma which is present in virtually all asthmatics with current symptoms. Airway inflammation plays an important role in BHR. It has been suggested that some of the macrolide antibiotics have anti-inflammatory properties and are shown to be effective in the treatment of asthma. The aim of this study was to evaluate the effects of a new synthetic macrolide antibiotic, clarithromycin, on the BHR to metacholine in patients with asthma. We studied 40 patients with bronchial asthma under treatment (budesonide 400 mcg b.i.d. and salbutamol 200 mcg p.r.n. (up to two times weekly). Subsequently, in one group of 20 patients (8 males/12 females, aged 42±12 ) we added 250 mg of clarithromycin b.i.d. for 8 weeks. The remaining 20 patients (5 males/15 females, aged 41±16) constituted the control group. In one subgroup of patients who received clarithromycin, cortisol levels were determined. Results: The PD20 of patients who received clarithrornycin was 0,5887±0,564 and 1,7194±0,684 before and after treatment respectively (p<0,001). The respective values of PD20 for the control group were 0,436±0,41 and 0,3909±0,505 (p=ns). Cortizol levels remained unchanged. We conclude that, clarithromycin reduces the degree of BHR in patients with asthma. Pneumon 1999, 12 (2): 117-122
     
  • SUMMARY Leukotriene antagonists are a newly introduced class of drugs for the treatment of asthma. Studies that have been published so far show that leukotriene antagonists have mild anti-inflammatory and bronchodilating effect and are particularly effective in treating Aspirin and Exercise induced asthma. In the 1997 ATS and the 1998 GINA Guidelines, Leukotriene antagonists are included and their use is suggested for the treatment of mild and moderate asthma. Pneumon 1999, 12 (2): 123-132
     
  • SUMMARY Presentation of a case of extensive endobroncheal tuberculosis with concommitant tuberculous laryngitis in a background of long-term use of high-dose inhaled steroids. The likelihood of activation of dormant infection by the inhaled steroids is discussed. The late sequelae of endobroncheal disease are presented and the utilisation of corticosteroids in the prevention of bronchostenosis is discussed. Pneumon 1999, 12 (2): 133-140
     
  • SUMMARY A rare case of congenital cystic adenomatoid malformation of the lung is presented. The patient had a history of recurrent lung infections of the right lower lobe, which were reported since his childhood. The x-ray as well as the computerized scanning tomography of the chest showed an abnormality of the right lower lobe with central cavitation. The patient was submitted to right thoracotomy and a lower lobectomy was performed. The postoperative course was uneventful and the patient was discharged from the hospital one week postoperatively with a normal chest x-ray. Pneumon 1999, 12 (2): 141-146
     
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