Bronchoalveolar lavage in sarcoidosis

A characteristic feature of BAL in patients with sarcoidosis is an increase of the total cell number, lymphocytes percent, or CD4/CD8 ratio of T lymphocytes. With respect to T lymphocytes, sarcoidosis has been recognized as a granulomatous disease characterized by dominant expression of Th1 cytokines. Recently Th1 cytokine profile in both CD4+ and CD8+ T lymphocytes in BAL fluid were demonstrated at the single-cell level. Furthermore, alveolar macrophages collected from BAL fluid were also investigated. Increased expression of 25-hydroxyvitamin D3 1 alpha-hydroxylase with mRNA level in alveolar macrophage were revealed in active sarcoidosis. Previously we showed that the B allele of the vitamin D receptor gene polymorphism may be regarded as a risk factor in the onset of sarcoidosis. The metabolism of vitamin D may be related to granuloma formation.     

Susceptibility to smoking among White and Chinese nonsmoking adolescents in Canada

OBJECTIVE: To document the prevalence of susceptibility to smoking among a sample of White/Caucasian and Chinese Canadian adolescent nonsmokers, and to explore the factors that might explain who is susceptible to smoking. DESIGN: This study used a secondary analysis of data from students participating in the British Columbia Youth Survey on Smoking and Health in 2001/2002. SAMPLE: The sample included 1,870 10th and 11th graders who were nonsmokers with either a White or a Chinese ethnic background. MEASUREMENTS: Questionnaire data consisted of demographic and social factors, previous smoking experience, and susceptibility to smoking. RESULTS: Among the total sample, 27.7% were susceptible to smoking. Multivariate logistic regression analysis revealed that 11th graders were less susceptible than 10th graders (odds ratio [OR]=0.80, 95% confidence interval [CI] 0.64-0.99), and girls were more susceptible than boys (OR=1.32, 95% CI 1.05-1.65). Ethnicity did not help to explain susceptibility to smoking in this study. CONCLUSIONS: The findings indicated the effects of gender and grade on predicting susceptibility to smoking. Even though the Chinese Canadian adolescents had the same risk of susceptibility to smoking as White/Caucasians, the factors that put them at risk may be different, which suggests the need to further examine the ethnic-specific predictors of susceptibility to smoking.     

Variation of proliferative activity in leukemic cell populations of patients with acute leukemia

In 31 children with acute leukemia, the proliferative activity of the leukemic marrow cell population as measured by mitotic and labeling indexes varied widely from patient to patient and from one disease stage to another. Leukemic marrow had a small but statistically significant diurnal variation of proliferative activity. Changes in labeling indexes were directly related to changes in the proportion of large dividing blasts in the marrow. Generation times of dividing leukemic blast cells in 3 patients were similar at diagnosis and in relapse. Changes in proliferative activity of leukemic marrow can be explained by progressive accumulation of nondividing leukemic cells.     

Smoking in closed space and its effect on carboxyhaemoglobin saturation of smoking and nonsmoking subjects

The effect of tobacco smoking in a closed space on blood COHb saturation was investigated in a group of 21 smokers and 28 nonsmokers. Each of the smoking subjects smoked 6 cigarettes, starting a new one every 15 minutes. At the end of the experiments the mean CO concentration in the room was about 30 ppm, which is about normal for smoky rooms. The blood COHb saturation increased in the smoking group from 5.3 (2.1 SD) to 9.1 (2.1 SD)%. In the nonsmoking group the increase was from 1.6 (0.6 SD) to 2.2 (0.6 SD)%. The mean increase in nonsmoking group was as much as smoking one cigarette. Extrapolated to an eight hour period this suggests that a nonsmoking subject would inhale tobacco smoke equivalent to about five cigarettes.     

Bronchoalveolar hemostasis in lung injury and acute respiratory distress syndrome

Summary. Enhanced intrapulmonary fibrin deposition as a result of abnormal broncho‐alveolar fibrin turnover is a hallmark of acute respiratory distress syndrome (ARDS), pneumonia and ventilator‐induced lung injury (VILI), and is important to the pathogenesis of these conditions. The mechanisms that contribute to alveolar coagulopathy are localized tissue factor‐mediated thrombin generation, impaired activity of natural coagulation inhibitors and depression of bronchoalveolar urokinase plasminogen activator‐mediated fibrinolysis, caused by the increase of plasminogen activator inhibitors. There is an intense and bidirectional interaction between coagulation and inflammatory pathways in the bronchoalveolar compartment. Systemic or local administration of anticoagulant agents (including activated protein C, antithrombin and heparin) and profibrinolytic agents (such as plasminogen activators) attenuate pulmonary coagulopathy. Several preclinical studies show additional anti‐inflammatory effects of these therapies in ARDS and pneumonia.     

Idiotype variant cell populations in patients with B cell lymphoma

Using isolated idiotype (Id) protein we generated panels of antibodies in two patients with follicular lymphoma, one of whom had never received prior chemo-or radiotherapy. Flow cytometry and frozen section tissue staining of tumor with these monoclonal antibodies (mAb) revealed multiple subpopulations within each tumor. Individual mAb stained between 7% and 83% of surface Ig+ cells in the tumor samples. These subpopulations were overlapping and no single antibody recognized all the tumor cells. However, combinations of antibodies seemed to capture total tumor in both cases. In some instances, the percentage of tumor stained by a single mAb varied over time, and differed between lymph nodes sampled at the same time. Because a single species of Id protein was used to generate mAb in each case, it appears that the antibodies were directed against idiotopes variably shared by different populations within each tumor, and this was confirmed by crossblocking studies. Tumor cells from one patient were fused to a nonsecreting heteromyeloma line K6H6/B5, and most of the resulting hybrids secreted Id protein. Four mAb were used to screen the Id proteins secreted by these hybrids, and 11 different variants (16 maximal) were found. Southern blot analysis of rearranged Ig genes was done in two hybrids and biopsy material. Identically rearranged light-chain genes were seen but it appeared as though extensive somatic variation had occurred in heavy chain genes. These studies indicate that: striking Id variation can exist at diagnosis in untreated patients, the percentage of tumor represented by an individual variant may change with time and may differ between tumor sampled from different anatomical locations, and somatic variation appears to be responsible for the observed heterogeneity. Although this degree of variation makes anti-Id antibody therapy more difficult, appropriate combinations of mAb should be more efficacious than single antibodies in such cases.     

Alpha-1-antitrypsin content in the serum, alveolar macrophages, and alveolar lavage fluid of smoking and nonsmoking normal subjects.

The content of alpha-1-antitrypsin in the serum, alveolar lavage fluid, and alveolar macrophages of smokers and nonsmokers was studied. Bronchoalveolar lavage was used to obtain alveolar fluid and macrophages from normal volunteers, and alpha-1-antitrypsin and albumin were measured using the electroimmunodiffusion technique. The serum level of inhibitor was not different between the two groups, while the total lavage fliud content of alpha-1-antitrypsin was increased in the smokers. The level of alpha-1-antitrypsin was also significantly greater (P less than 0.001) in the alveolar macrophages of the smokers suggesting the possibility of chronically increased alveolar levels in the cigarette smoker as a possible protective mechanism against proteolysis.     

Bronchoalveolar lavage in acute drug-hypersensitivity pneumonitis probably caused by phenytoin

We have reported a case of acute hypersensitivity pneumonitis, probably caused by phenytoin, in which the results of bronchoalveolar lavage suggested a predominantly lymphocytic type of alveolitis, comparable to the alveolitis of sarcoidosis or chronic hypersensitivity pneumonitis.     

Smoking habits and predictors of continued smoking in patients with acute coronary syndromes

BACKGROUND: Most patients with acute coronary syndrome quit smoking when hospitalized, although several have been found to relapse and resume smoking within 3 months. AIM: This paper reports a study to identify factors that can predict who will resume smoking after hospitalization for an acute coronary syndrome. METHODS: Patients (n = 1320) below the age of 75 years, admitted to a Swedish university hospital coronary care unit with acute coronary syndromes, between September 1995 and September 1999, were consecutively included. Data were collected from hospital medical records and included information on previous clinical history, former illnesses and smoking. During their hospitalization, an experienced nurse interviewed the patients by using a structured questionnaire to obtain additional information. Patients were followed up 3 months after the discharge. Those who continued to smoke (non-quitters) were compared with those who had stopped (quitters) with regard to age, sex, medical history, clinical course, and intention to quit. To identify factors independently related to continued smoking, a logistical regression in a formal forward stepwise mode was used. RESULTS: Of the patients admitted, 33% were current smokers. Three months after discharge, 51% of these patients were still smoking. There were no significant differences in age, gender or marital status between non-quitters and quitters. In a multivariate analysis, independent predictors of continued smoking were: non-participation in the heart rehabilitation programme (P = 0.0008); use of sedatives/antidepressants at time of admission (P = 0.001); history of cerebral vascular disease (P = 0.002), history of previous cardiac event (P = 0.01); history of smoking-related pulmonary disease (P = 0.03) and cigarette consumption at index (P = 0.03). CONCLUSIONS: Smoking patients who do not participate in a heart rehabilitation programme may need extra help with smoking cessation. The findings may provide means of identifying patients in need of special intervention.     

Effect of gradually increasing carboxyhaemoglobin saturation on visual perception and psychomotor performance of smoking and nonsmoking subjects

The effect of gradually increasing COHb saturation on human visuoperceptual and psychomotor performance was studied in 22 nonsmokers and 22 smokers. Each subject performed two sessions in randomized order, one during air breathing and the other during CO breathing on two separate days. Testing and COHb saturation measurement were repeated six times during each session. Gas breathing was between the test periods. The increase of COHb saturation up to 12--13 per cent units had no effect (p greater than 0,05) on perceptual speed and accuracy as measured by the Bourdon--Wiersma test. Finger tapping speed was also unaffected. Visual perception measured with critical flicker frequency (CFF) was sensitive to CO. The gradual increase in COHb saturation caused a linear decrease in CFF in the both groups. An increase of one per cent unit in COHb saturation caused significant decrease in CFF (p less than 0.001), when intraindividual changes were taken into account. During acute exposure to CO there was no difference in any test performance between the groups. During air preathing there was no difference in performance although there was a significant difference (p less than 0,001) in the COHb saturation levels. This negative finding might be due to adaptation of smokers to chronic exposure of CO because of smoking.     

Dyslipidemia and oxidative stress in sarcoidosis patients

ObjectivesSarcoidosis is an inflammatory disease characterised by enhanced production of reactive oxygen species and alterations in the circulating lipid profile. Both attributes are thought to play a role in its pathogenesis. However, current knowledge regarding the significance of blood oxidative stress/anti-oxidant defence as well as alterations in lipid status parameters in sarcoidosis is scarce. The aim of our study was to assess these parameters and their inter-relationships, as well as their potential for patient-control discrimination.Design and methodsOxidative stress status and anti-oxidant defence parameters were determined in serum and erythrocytes and lipid status parameters were assessed in the serum of 213 treated sarcoidosis patients and 90 controls.ResultsMalondialdehyde, superoxide anion, total oxidant status, prooxidant–antioxidant balance and triglycerides were significantly higher whereas total anti-oxidant status, superoxide dismutase activity and HDL-cholesterol were significantly lower in sarcoidosis patients compared with controls. Total sulfhydryl group content was higher in patients compared with controls. Serum and erythrocyte malondialdehyde exhibited the strongest ability to predict disease presence. Elevated oxidative stress was characterised by higher clinical accuracy compared with lipid status abnormality. Some oxidative stress and lipid status markers were significantly associated in sarcoidosis.ConclusionsSarcoidosis is characterised by increased oxidative stress, diminished overall anti-oxidative protection and alterations in the circulating lipid profile. Both oxidative stress and lipid status parameters demonstrated the potential to discriminate sarcoidosis from controls which was particularly evident from the point of view of oxidative stress status parameters. Association between these parameters may indicate an increased risk for atherosclerosis development.     

Bronchoalveolar lavage cytological alveolar damage in patients with severe pneumonia

Introduction  

Histological examination of lung specimens from patients with pneumonia shows the presence of desquamated pneumocytes and erythrophages. We hypothesized that these modifications should also be present in bronchoalveolar lavage fluid (BAL) from patients with hospital-acquired pneumonia.     

Theoretical applications of smoking cessation interventions to individuals with medical conditions: women's initiative for nonsmoking (WINS)-part III.

This paper reviews the Theory of Self-Efficacy, Transtheoretical Model of Readiness for Change, and Theory of Addictions to provide a basis for smoking cessation, and explores how these theories have been used to guide clinical research and clinical interventions. Selected randomized controlled trials of the past ten years are reviewed for demonstrated efficacy, integration of theory into the design of the interventions, and how theories guide analysis. Results show that surprisingly little effort has been put forth to examine and develop these theories within the context of clinical interventions, despite the claims of importance. For example, the relationship between stages of readiness of change and smoking cessation outcome has not been examined. Despite the complexity of smoking behaviors (quitting, relapsing, maintaining, occasional smoking and so on), the concept of self-efficacy was mostly measured on single occasions over the course of most studies reviewed; multiple measurements of concepts were not utilized in the randomized controlled trials. Taking into account the gaps between theory and application, theory driven nursing strategies are offered.     

Bronchoalveolar lavage in diagnosis of ventilator-associated pneumonia in patients with burns

Ventilator-associated pneumonia (VAP) remains a major cause of morbidity and mortality for patients with burns. In nonburn populations, bronchoalveolar lavage (BAL) excludes other pathology such as systemic inflammatory response syndrome. We hypothesized that BAL would decrease our false-positive VAP rate. All ventilated patients with burn injury who were admitted to our institution from July 2000 through June 2003 were included. After June 2001, BAL was used to make the diagnosis of VAP, with > or =10(4) organisms considered a positive result. Fifty patients met criteria for VAP, 21 in the pre-BAL period and 29 in the BAL period. Six patients (21%) in the BAL group had quantitative cultures <10(4) and were not treated. The outcomes for these patients were not different than those treated for VAP. There were no differences in age, TBSA size, antibiotic use, or ventilator days for the pre-BAL or BAL groups, although the pneumonia rate was lower for the BAL time period. The use of BAL eliminated the unnecessary antibiotic treatment of 21% of patients in the BAL time period and was associated with a lower rate of VAP.