Anticardiolipin antibodies and cellular bronchoalveolar lavage as active tools for early diagnosis of subclinical pulmonary involvement in rheumatoid arthritis

Subclinical pulmonary involvement in rheumatoid arthritis [RA] was assessed by anticardiolipin antibodies [ACA] estimation in 30 patients and cellular bronchoalveolar lavage analysis [BAL] in 20 of them. All patients had no clinical manifestations of pulmonary involvement and had normal chest roentgenograms, normal pulmonary function tests and normal blood gases. Abnormal differential BAL count was detected in 35% of the 20 studied patients, 86% of them had lymphocytic alveolitis and 29% had neutrophilic alveolitis. So, BAL could used as a sensitive tool in detecting early pulmonary involvement in RA. High IgG ACA and/or IgM ACA were present in sera of 27% of the 30 patients. There was significant association between BAL abnormalities and the severity of RA as demonstrated by C-reactive protein level. High ACA level was found in patients with severe RA as demonstrated by presence of one or more extra-articular manifestations in 88% and high C-reactive protein in all of them compared with those with normal ACA level. Patients with abnormal BAL had significant high ACA [IgA and/or IgM] than those with normal BAL. The study suggested that BAL in addition to ACA analysis are of value in the early diagnosis of pulmonary involvement in patients with RA for early therapeutic intervention before the development of irreversible lesions

Lymphocyte alveolitis in HAM/TSP patients: preliminary report

Mielopatia por HTLV-I (HAM) tem sido descrita como doença sistêmica caracterizada pelo acometimento de vários órgäos além do sistema nervoso. Neste registro, estamos relatando o envolvimento pulmonar em pacientes com HAM

Cytological diagnosis of bronchial malignancies using the fibreoptic bronchoscope.

Bronchial brush and wash material were obtained by fibreoptic bronchoscopy in 200 patients suspected of having bronchial carcinoma. Malignancy was diagnosed in 42, giving a diagnostic yield of 21%. Bronchial brush material showed the highest yield. Morphological cell typing was done on cytological material. Technical considerations, diagnostic criteria, diagnostic yield and accuracy are discussed.

Compromiso pulmonar intersticial en artritis reumatoide: análisis por lavado bronco-alveolar / Interstitial pulmonary involvement in rheumatoid arthritis: analysis by bronchoalveolar lavage

We analyzed the reuslts of bronchoalveolar lavage (BAL) in 14 patients with Rheumatoid Arthritis. Teh patients had total cell counts above 10 x 10***6/100 ml and or more than 10½ lymphocytes in differential counts. 40% of patients with normal clincial findings on pulmonary examination and normal A-a 02 gradients had abnormal BAL findings. These findings support the theory that pulmonary fibrosis in patients with RA may start with alveolitis, probably a lymphocytic in 60% of cases. BAL may help early diagnosis and treatment monitoring

diagnostic value of transtracheal lavage: I- Cytopathological and parasitological findings of lavage fluids in some respiratory affections in equines

Transtracheal lavage procedure was used to obtain samples of respiratory secretions from tracheobronchial level of apparently normal conscious horses and donkeys as well as from horses and donkeys suffering from some respiratory infections. The sampling technique was safe and rapidly applicable without complications. The cellular composition of the lavage fluids was assessed and the parasitological findings were determined. There was a significant increase [P < 0.001] in total cell count of lavage fluids in cases of bronchopneumonia and aspiration pneumonia both in horses and donkeys. A signficant increase [P < 0.001] in total cell count was also observed in cases of lungworm in donkeys. The differential cell count revealed a significant increase [P < 0.001] in neutrophils percent and a significant decrease [P < 0.001] in macrophage percent in cases of bronchopneumonia and aspiration pneumonia. A significant increase [P < 0.001] in eosinophils and mast cells percent were observed in cases of lungworm in donkeys. Parasitologically, the eggs containing larvae of lungworm were detected, for the first time, in lavage fluids in donkeys and the hatched larvae were identified [Dictyocaulus arnfieldi]. In conclusion, lavage fluid examination provides a simple and valuable aid to the diagnosis of respiratory diseases in equine

Alteraciones citologicas en el lavado broncoalveolar de los pacientes en tratamiento con amiodarona / Cytologic alterations in bronchoalveolar lavage in amiodarone treated patients

Once pacientes en trtamiento con amiodarona por presentar arritmias ventriculares severas fueron evaluados clínica y radiológicamente y considerados exentos de toxicidad pulmonar por la droga. Se efectuó fibrobroncoscopía y lavado broncoalveolar (BAL) realizando el estudio citológico del material obtenido y se continuó la administración de amiodarona independientemente de los resultados del mismo. Los hallazgos del BAL mostraron la presencia de depósitos lipídicos en los macrófagops alveolares, expresados como células espumosas en la microscopía óptica y como cuerpos de inclusión lamelares en la microscopía electrónica. En la mitad de los pacientes se detectó la existencia de alteraciones en el recuento celular diferencial del líquido de BAL, indicativas de alveolitis. En este grupo de pacientes la PaO2 y la relación PaO2/PAO2 fueron significativamente menores al resto (76 ñ 9 vs 89 ñ 5 mmHg y 0,72 ñ 0,1 vs 0,85 ñ 0,08, respectivamente; p < 0,05). Al cabo de un año 5 de los pacientes (2 pertenecientes al grupo com "alveolitis") continuaban tomando la droga sin presentar evidencias clínicas de toxicidad pulmonar. Estos resultados muestran que la presencia de macrófagos espumosos o cuerpos lamelares en el BAL de pacientes en tratamiento con amiodarona es un dato inespecífico que carece de valor para el diagnóstico de toxicidad pulmonar por la droga. Simismo se advierte que un alto porcentaje de pacientes puede presentar alveolitis detectable por hipoxemia y alteraciones citológicas en el BAL, que aparentemente no progresa hacia formas clínicamente manifiestas de toxicidad

Bronchoalveolar lavage--cellular characteristics in patients with idiopathic pulmonary fibrosis and sarcoidosis.

Bronchoalveolar lavage (BAL) was carried out in 30 patients of idiopathic pulmonary fibrosis (IPF), 10 patients of sarcoidosis and 10 normal subjects who served as controls. The total cell counts were higher both in the IPF (24.8 x 10(5)/ml) and sarcoidosis (19.3 x 10(5)/ml) as compared to the normal controls (9.8 x 10(5)/ml). The difference was statistically significant in both the groups (p less than 0.001 and less than 0.05 respectively). Patients with IPF showed a predominant polymorphonuclear response although the lymphocytes were also increased whereas patients of sarcoidosis had a lymphocytic response in the BAL fluid. In 6 patients with IPF the study was repeated after 6 weeks of steroid therapy and a decrease in the total cell count and polymorphonuclear cells (%) was noted.

Intoxicación experimental por paraquat: correlación entre el recuento celular diferencial del lavado broncoalveolar y la histopatología pulmonar / Paraquat experimental intoxication: correlation between diferential cell count of the bronchoalveolar lavage and pulmonary histopathology

El paraquat es un hervicida ampliamente usado en agricultura. Evidencias clínicas y experimentales han mostrado que el paraquat puede causar daño pulmonar intenso produciendo un síndrome de distress respiratorio del adulto. El grado de alveolitis demostrado por el recuento celular diferencial en el lavado broncoalveolar (LBA) se relacionó con el daño histológico del pulmón, usando un modelo experimental de daño pulmonar agudo inducido por paraquat. El paraquat fue administrado a 34 ratas en una dosis única intraperitoneal de 2 ó 15 mg/Kg. Las ratas se sacrificaron 5 ó 48 h. después y los resultados se compararon con la serie control (ratas inyectadas con Na Cl 0,90%). En todas las series tratadas con paraquat se demostró un aumento significativo de los polimorfonucleares (PMN) y linfocitos y una disminución significativa en el recuento de macrófagos del lavado broncoalveolar (LBA). Sin embargo, el recuento total de células del LBA no demostró diferencias significativas comparado con la serie control

Persisting alveolitis in miliary tuberculosis despite treatment with short-course chemotherapy.

Bronchoalveolar lavages in two patients with miliary tuberculosis have shown lymphocytic alveolitis. A 6-month regimen with an initial intensive 2-month phase resulted in remarkable clinical and radiographic improvement in both. However, bronchoalveolar lavage following treatment has shown that there was a persistence of lymphocytic alveolitis, though with reduced intensity. The significance of the persisting alveolitis, despite treatment, is not known at present. There is also a suggestion that compartment-alisation of lymphocytes may occur in miliary tuberculosis of the lung.

Value of bronchoalveolar lavage in interstitial lung diseases.

Fifty-eight patients of interstitial lung diseases and 30 control patients were submitted to bronchoalveolar lavage (BAL) with flexible fibreoptic bronchoscopy. In 30 controls (with fluid recovery 61.7%) total cell count was 175 +/- 31/mm3 with macrophages 87.5 +/- 2.0%, neutrophils 7 +/- 1.9 and lymphocytes 5 +/- 0.6%. In idiopathic interstitial fibrosis (34 cases) these values were respectively 832 +/- 221/mm3, 47 +/- 5.5, 29 +/- 5.0 and 19 +/- 5 percent (significantly different P: less than 0.005, 0.001, 0.1 and 0.005 respectively from control. The results of bilateral lavages in 28 interstitial cases were similar. In other categories viz: sarcoidosis(8), macrophages were significantly fewer (61 +/- 10%: P less than 0.05) and lymphocytes significantly more (27 +/- 6.4%: P less than 0.05); in rheumatoid lung disease (4 cases) significantly fewer macrophages (45 +/- 5) were seen and 12 cases with methyl isocyanate exposure showed insignificant changes.

Pneumonite intersticial linfocitária / Lymphocitic interstitial pneumonia

Pneumonite intersticial linfocitária é doença de etiologia obscura, considerada imunomediada. Encontra-se no polo benigno das doenças linfoproliferativas de pulmäo, podendo, porém, evoluir para linfoma. Apresentamos o caso de uma mulher negra, 39 anos de idade, com história de sete meses de tosse, chiado dor torácica, dispnéia e emagrecimento de 5 kg, com infiltrado nodular confluente predominando em bases pulmonares ao RX de tórax. O diagnóstico através de biopsia pulmonar a céu aberto foi de pneumonite intersticial linfocitária. Foi tratada com corticosteróide, com boa evoluçäo clínica, radiológica e funcional