ABSTRACT
OBJECTIVE: The lactulose H2-breath test is the most widely used non-invasive approach for evaluation of orocoecal transit time (OCTT). In the present study, doubly-labelled lactose-[13C, 15N]ureide (DLLU) was synthesized to investigate the OCTT in comparison to the conventional lactulose H2-breath test. Additionally the bacterial breakdown rate (BBR) and rate of elimination and the metabolic pathways of the cleavage products of DLLU (13CO2, [15N]urea, and 15NH3) were investigated. DESIGN AND SUBJECTS: In a first study, DLLU was administered as a single oral-pulse-labelling (dosage: one gram) either without and after pretreatment of five grams of unlabelled lactoseureide (LU) on the day prior to the study to twelve healthy adult volunteers after breakfast. Breath and urine were collected in one and two hour-intervals, respectively, over a one-day period. 13C-enrichment in breath as well as 15N-enrichment in urine fractions were measured by continuous flow-isotope ratio mass spectrometry (CF-IRMS). In a second study, lactulose was administered to the same subjects (dosage: ten grams). Breath was collected in quarter, half and one hour-intervals over a ten hour-period. Hydrogen concentration in breath was analysed using an electrochemical detector. RESULTS: The comparison of the lactose-[13C]ureide 13CO2-breath test and the lactulose H2-breath test showed that the mean increase of the 13C-enrichment in CO2 occurred 1.18 h later than the mean increase of H2 in breath. The resulting OCTTs derived from the two methods were 3.02 +/- 1.4 and 1.84 +/- 0.5 h (P < 0.05) and the corresponding BRs were 9.63 +/- 3.4 and 6.07 +/- 1.7 h (P < 0.01), respectively. The 15N-enrichment of urinary urea and ammonia without and after pretreatment with LU started between two and three hours after DLLU-administration. The cumulative percentage urinary excretion of the 15N- and 13C-tracer was 29.9% and 13.6% respectively, and was slightly increased after LU-pretreatment to 32.1% and 14.6% of the dose administered. A total of 35.2% of the 13C was found to be exhaled and remained approximately constant after LU-pretreatment (36.2%). CONCLUSIONS: The use of the lactulose H2-breath test for evaluation of the OCTT showed a statistically significant shortening of 1.18 h in comparison to the lactose-[13C]ureide 13CO2-breath test in healthy adults. The most important limitations of the lactulose H2-breath test are its low specificity and sensitivity due to dose-dependent accelerations of OCTT, interfering H2-rise from malabsorbed dietary fibre and H2-non-producers. In contrast, our lactose-[13C]ureide 13CO2-breath test was confirmed to avoid these disadvantages and to yield reliable results. This test is recommended especially if higher sensitivity and specificity is required, if IRMS-technique is available and if lactulose H2-tests lead to insufficient results.
Subject(s)
Breath Tests , Gastrointestinal Transit , Lactose , Lactulose , Urea , Carbon Isotopes , Cecum , Humans , Nitrogen IsotopesABSTRACT
Thiocyanate (SCN-) concentrations in serum samples of 32 cystic fibrosis (CF) patients, 30 controls as well as 23 heterozygotes (parents of CF patients) were investigated, because SCN- influenced viscosity of secretions, membrane functions as well as nonspecific and specific defense processes. CF patients showed little smaller SCN- serum levels, but the differences were not statistically significant. There were remarkable smaller values for CF patients with most serious clinical conditions due to severe pulmonary changes.
Subject(s)
Cystic Fibrosis/blood , Thiocyanates/blood , Adolescent , Child , Child, Preschool , Cystic Fibrosis/diagnosis , Cystic Fibrosis/genetics , Genetic Carrier Screening , Humans , Lung/pathology , PrognosisABSTRACT
With a view of the pathogenesis of chronic bronchopulmonary diseases the interrelations between infections and evolving defense system are of interest, they are perhaps detectable by means of diagnostic bronchoalveolar lavage. We carried out cytodifferentiation, investigated adenosine deaminase activities and interleukin 1 formation of macrophages, determined immunoglobulin concentrations (secretory IgA), lysozyme, alpha 2-macroglobulin, alpha 1-antitrypsin, albumin. Because the cytodifferentiation yields insight into topical inflammatory reactions, shows diagnostic useful informations in single cases and because it is simple to carry out we can recommend it for each bronchological examination. There were no results specific for any disease group for parameters mentioned above.
Subject(s)
Bronchoalveolar Lavage Fluid/cytology , Immunologic Deficiency Syndromes/diagnosis , Lung Diseases, Obstructive/diagnosis , Respiratory Tract Infections/diagnosis , Adenosine Deaminase/analysis , Adolescent , Bronchoalveolar Lavage Fluid/chemistry , Child , Child, Preschool , Female , Humans , Immunoglobulin A/analysis , Immunoglobulin G/analysis , Immunologic Deficiency Syndromes/immunology , Infant , Interleukin-1/analysis , Leukocyte Count , Lung Diseases, Obstructive/immunology , Macrophages/immunology , Male , Muramidase/analysis , Respiratory Tract Infections/immunology , Serum Albumin/analysis , alpha 1-Antitrypsin/analysisABSTRACT
Autogenic drainage, PEP mask breathing as well as physical exercise are now well established in the treatment of pulmonary disease in cystic fibrosis, but there are different opinions about oxygen therapy over a long period as well as corticosteroid treatment. First reports on amiloride inhalations seem to be hopeful, but there is no experience with cystic fibrosis children till now, therefore clinical use can not be recommended. Heart lung transplants are not to consider as an alternative treatment for all cystic fibrosis patients, in special cases it may be successful.
Subject(s)
Cystic Fibrosis/therapy , Child , Combined Modality Therapy , Humans , Quality of LifeABSTRACT
Increased sIgA values were found in CF patients in about 70 per cent (3 studies with 23, 43, 45 CF patients). With higher severity of CF disease (Shwachman score) we could observe higher sIgA levels. Postmortem histological findings and sIgA concentrations correlated well in 13 cases. Determinations of sIgA in serum could serve as parameter for hepatobiliary involvement in CF. Secretory immunoglobulin A (sIgA) is the predominant immunoglobulin of exocrine secretions. In serum large and frequent elevations of sIgA could be found in patients with chronic liver disease characterized by biliary obstruction (3). Slight and irregular elevations were observed in patients with disorders of gastrointestinal tract and of respiratory tract as well as in lactating women (3). Manifestations of the hepatobiliary system in CF will become more important with advancing age and progressively higher life expectancy of CF patients. A simple reliable test for detection of hepatobiliary involvement in CF would be useful.
Subject(s)
Cystic Fibrosis/immunology , Immunoglobulin A, Secretory/blood , Biliary Tract Diseases/complications , Biliary Tract Diseases/immunology , Cystic Fibrosis/complications , Humans , Liver Diseases/complications , Liver Diseases/immunologyABSTRACT
Incubation of polystyrene latex particles with CF serum leads to reduced electrophoretic mobility (EPM) measured by a particle electrophoresis device. About 85% of 50 CF patients, 60 CF heterozygotes and 190 controls (healthy subjects and patients with different disorders) could be identified correctly.
Subject(s)
Cystic Fibrosis/diagnosis , Adsorption , Cystic Fibrosis/blood , Cystic Fibrosis/genetics , Electrophoresis , Female , Heterozygote , Humans , Male , PolystyrenesABSTRACT
In 20 years (1965 to 1984) 428 infants (604 investigations) in the first year of life were bronchoscoped in our hospital; 109 out of them were newborns (119 investigations). Bronchographies were performed in 94 infants including 2 newborns. In the last 10 years the number of investigations decreased. Most frequent indications of bronchoscopies were stridor, aspiration and atelectasis. The usefulness of bronchological investigations in patients with oesophago-tracheal fistula, tracheal stenosis following long time intubation and bronchopulmonary dysplasia is pointed out. The diagnostic bronchoalveolar lavage can be recommended for newborns and infants too.
Subject(s)
Bronchography , Bronchoscopy , Infant, Premature, Diseases/diagnosis , Respiratory System Abnormalities , Respiratory Tract Diseases/congenital , Humans , Infant , Infant, Newborn , Respiratory Tract Diseases/diagnosisABSTRACT
While the effectiveness of bronchoalveolar lavage (BAL) in pediatric therapy has been recognized for years, there are hardly any data on its usefulness in diagnosis, its performance and compatibility in childhood. After 123 bronchological investigations including BAL on 118 children in the age of three months through 16 years, with lavage fluid amounts between 40 and 160 ml, febrile reactions occurred in 17 cases (= 13.8%), i.e. no more frequent than in a group of 100 children bronchologically investigated but without BAL. After blood gas analyses, ECG examinations, blood pressure readings the compatibility of BAL turned out to be good in children of every age. Bronchography pictures after BAL were not reduced in quality, atelectasis formation occurred rarely.
