Adult domiciliary oxygen therapy. Position statement of the Thoracic Society of Australia and New Zealand

Patients with chronic obstructive pulmonary disease and a stable daytime PaO2 of < or = 55 mmHg (7.3 kPa) live longer and have a better quality of life if provided with long-term continuous oxygen therapy. It is reasonable to offer continuous oxygen therapy also to patients with other lung diseases that cause chronic hypoxaemia. Indications for supplemental oxygen therapy during exercise (ambulatory oxygen therapy) and sleep (nocturnal oxygen therapy) are less clear.     

Inhaled mannitol for the treatment of mucociliary dysfunction in patients with bronchiectasis: effect on lung function, health status and sputum

OBJECTIVE: Inhaled mannitol increases mucus clearance in patients with bronchiectasis by an unclear mechanism. The effect of mannitol on lung function, health status and sputum properties was investigated. METHODOLOGY: Nine patients with bronchiectasis inhaled 400 mg of mannitol once daily for 12 days. Health status was assessed using the St George's Respiratory Questionnaire (SGRQ). Sputum was analysed for viscosity, elasticity, spinnability, surface tension, contact angle, solids, mucociliary transportability (MCTR) on a frog palate, and cough transportability (CTR) on a simulated cough machine. RESULTS: Lung function was unchanged with treatment (baseline FEV1 82.0 +/- 16.2%) apart from an improvement in FEF from 85.4 +/- 13% (baseline) to 90.7 +/- 14.4% (P < 0.05; 12th treatment; visit 7). The total SGRQ score (mean +/- SD) of 49.3 +/- 13.8 at baseline, decreased by 12.4 +/- 10.2 (P < 0.01; visit 7) and 10.1 +/- 9.4 units (P < 0.02) 6-10 days after treatment cessation. The baseline subscores for symptoms (72.9 +/- 11.8), activity (44.7 +/- 20.9) and impact (44.4 +/- 14.3) were reduced by 0.8 +/- 9.1 (P > 0.7), 8.4 +/- 16.0 (P > 0.1) and 19.2 +/- 13.7 (P < 0.005) units, respectively (visit 7). Mannitol reduced the baseline (mean +/- SE) surface tension from 94.5 +/- 1.4 to 84.7 +/- 2.1 mN/m (P < 0.0001), contact angle from 51.1 +/- 2.8 to 33.2 +/- 2.4 degrees (P < 0.0001), spinnability from 11.6 +/- 0.4 to 10.0 +/- 0.2 mm (P < 0.005), and solids from 5.7 +/- 0.4 to 4.3 +/- 0.7% (P < 0.02), acutely (visit 7). Viscosity, elasticity and MCTR did not change significantly, while CTR was increased from 25.8 +/- 1.0 to 34.1 +/- 2.7 mm (P < 0.003). CONCLUSION: Mannitol significantly improved the health status over 12 days and this improvement was maintained for 6-10 days after cessation of treatment. In addition, mannitol reduced the tenacity, increased the hydration of mucus acutely and improved cough clearability in patients with bronchiectasis.     

Cytoskeletal, synaptic, and nuclear protein changes associated with rat interface organotypic hippocampal slice culture development

Although organotypic hippocampal slice cultures (OHSCs) are used to study function within the hippocampus, the effect of maintenance in vitro upon protein expression is not fully understood. Therefore, we examined developmental changes in cultures prepared from P8 rats and maintained on porous membranes between medium and atmosphere. Between 7 and 28 days following explantation, altered hippocampal morphology could not be detected despite a significant decrease in both MAP-2c and a mid-range tau isoform by 21 DIV. During the same period, lower GFAP expression was observed, and GFAP labeling suggested a migration of astrocytes to the slice-atmosphere interface. In contrast, levels of the synaptic proteins synaptophysin and PSD-95 were significantly increased, but GAP-43 was not. The preservation of myelinated axons and synapses, along with glial and endothelial cells, was confirmed by ultrastructural analysis. Furthermore, intranuclear inclusion bodies, which are associated with normal aging in vivo, were detected in the CA1 pyramidal layer in cultures older than 14 DIV. When OHSCs were maintained for approximately 3, 4, and 10 weeks, a rise and then fall in the expression of synaptophysin and, especially, PSD-95 were found, and the biphasic trend paralleled by significant changes in Schaffer collateral-evoked excitatory post-synaptic potentials from CA1 neurons. Our data not only describe changes in cytoskeletal, synaptic, and nuclear proteins related to the maintenance of interface OHSCs, but also emphasize the potential of the model for the study of age-related phenomena within the hippocampus.     

Early signs of brain infarction at CT: observer reliability and outcome after thrombolytic treatment--systematic review

PURPOSE: To review systematically all reported early computed tomographic (CT) signs in acute ischemic stroke to determine interobserver agreement and the relationship between early CT signs and patient outcome with or without thrombolysis. MATERIALS AND METHODS: A systematic review of the literature was conducted by using Cochrane Stroke Group methodology to identify studies published between 1990 and 2003 that were performed to assess interobserver agreement about early signs of infarction on CT scans obtained within 6 hours after onset of stroke symptoms and determine the relation of early signs of infarction to clinical outcome, including any interactive effect of thrombolysis. Interobserver agreement was measured with the kappa statistic, sensitivity, and specificity. The relation of early signs to clinical outcome with or without thrombolysis was assessed with calculated odds ratios and 95% confidence intervals. RESULTS: In 15 studies of interobserver agreement (median of 30 CT scans and six raters), the prevalence of all early infarction signs was 61% +/- 21 (standard deviation). Interobserver agreement (kappa statistics) ranged from 0.14 to 0.78 for any early infarction sign. The mean sensitivity and specificity for detection of early infarction signs with CT were 66% (range, 20%-87%) and 87% (range, 56%-100%), respectively. Experience improved detection, but knowledge of symptoms did not. In 15 studies of early infarction signs and outcome (including seven thrombolysis trials) in 3468 patients, any early infarction sign increased the risk of poor outcome (odds ratio, 3.11; 95% confidence interval: 2.77, 3.49). Two studies that sought interaction between early infarction signs and thrombolysis found no evidence that thrombolysis given in the presence of early infarction signs resulted in worse outcome than that due to early signs alone. CONCLUSION: Further work is required to determine which signs are most reliably detected, whether scoring systems help to improve detection, and whether any early infarction sign should influence decisions concerning thrombolysis.     

PAHs and metals in the soils of inner-city and suburban New Orleans, Louisiana, USA

Representative soil samples of an inner-city and suburban community (n = 19 each) are evaluated for 16 polycyclic aromatic hydrocarbons—PAHs (naphthalene, acenaphthylene, acenaphthene, fluorene, phenanthrene, anthracene, fluoranthene, pyrene, benz(a)anthracene, chrysene, benzo[k]fluoranthene, benzo[j]fluoranthene, benzo(a)pyrene, indeno[1,2,3-cd]pyrene, dibenz[a,h]anthracene and benzo[g,h,i]perylene) and nine metals (Pb, Zn, Cd, Mn, Ni, Cu, Cr, Co and V). Surface (2.5 cm deep) samples were air-dried and sieved (2 mm USGS #10). Accelerated solvent extraction was used for PAH preparation prior to analysis with gas chromatography–mass spectrometry. Metals were extracted at a 5:1 ratio of 1 mol nitric acid to soil, shaken at room temperature, centrifuged, filtered and analyzed by inductively coupled plasma-atomic emission spectrometry (ICP-AES). Total PAHs (median 2927 ng g⁻¹ versus 731 ng g⁻¹) and the total metals (median 1323 μg g⁻¹ versus 183 μg g⁻¹) summarize differences (P < 0.0001) between the inner-city and suburb, respectively. A strong association exists between PAHs and metals for all 38 soil samples (correlation coefficient = 0.831, P < 0.00001). In terms of the specific sites of accumulation, both PAHs and metals show the same pattern: busy streets > foundations > residential streets > open areas. This study provides real-world data about various chemical mixtures which may be a factor of possible health disparities in sensitive populations, especially children, in different communities of New Orleans.     

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Fatal outcome in a patient with metastatic prostate cancer and acquired severe hypogammaglobulinemia with complete absence of mature peripheral blood B-cells

Common variable immunodeficiency (CVID) is the second most common immunodeficiency and may be classified according to the presence or absence of mature B-cells, the latter subgroup being exceedingly rare. We describe a 66-year-old patient who over six months developed profound hypogammaglobulinemia associated with a complete absence of circulating B-lymphocytes and had a fatal outcome. Immunophenotypic analysis of a bone marrow aspirate demonstrated a strongly reduced number of B-cell precursors (CD34+/CD19+) but normal numbers of CD34+/CD45+ hematopoietic progenitor cells. This case is remarkable with respect to its documented rapid evolution. Possible triggers are discussed, a combination of drug toxicities being the most likely.     

Clinical experience with large-core needle biopsies of the breast and evaluation of histopathology

OBJECTIVE: Interventional techniques allow a microinvasive diagnostic of breast lesions. We examined the reliability of large core needle biopsies for histologic diagnosis on breast lesions. MATERIAL AND METHODS: 143 ultrasound guided automated spring gun biopsies and 16 stereotactic guided vacuum-assisted device biopsies were analyzed. Indications included confirmation of malign or benign lesions and diagnosis of suspicious lesions. RESULTS: In 113 biopsies (71%) an invasive breast carcinoma was diagnosed, in 5 biopsies (3%) in situ/atypical lesions were seen and 38 cases (24%) showed benign lesions. Based on the bioptic results, 108 patients underwent subsequent surgery. An identical histology was seen in 100/108 patients (93%), 5 biopsies were false negative (5%) and 3 specimens yielded necrotic/insufficient material. The immunohistochemical results of percutaneous biopsies and surgical specimens were comparable. 17 out of 113 patients (15%) with biopsy proven carcinoma were treated with neoadjuvant therapy. 32/38 patients with benign lesions were follow-up clinically. CONCLUSION: Ultrasound- or stereotactic guided percutaneous biopsies are methods to confirm histological diagnosis. Based on the biopsy results the, number of surgical excisions can be reduced and treatment of biopsy proven carcinoma can be improved by individual presurgical planing.