ABSTRACT
OBJECTIVES: Recent studies have found cyclooxygenase-2 (COX-2) and its polymorphisms to be associated with sarcoidosis, being it significantly decreased in alveolar macrophages, with no information on the relationship between these polymorphisms and the rest of cells in bronchoalveolar layage (BAL). The present study aimed to investigate the potential association between COX-2 gene polymorphisms and the BAL cell profile including the CD4/CD8 ratio. MATERIAL AND METHODS: This observational cross-sectional study involved six hospitals in Spain. Patients diagnosed with sarcoidosis with a BAL performed were included. The following variables were recorded: age, gender, initial diagnostic methods, serum angiotensin-converting enzyme levels, pulmonary function tests, radiological stage, and the cellularity and CD4/CD8 ratio from BAL. Genotyping of four COX-2 polymorphisms (COX2.5909T>G, COX2.8473T>C, COX2.926G>C, and COX2.3050G>C) was undertaken on DNA extracted from peripheral blood lymphocytes using fluorescent hybridization probes. The relationship between the polymorphisms and the cellularity was done by means of a multiple linear regression, adjusting for gender. RESULTS: A total of 51 sarcoid patients (23 males, mean age: 45 +/- 15 years) were studied. CD4/CD8 ratio was significantly higher among homozygote allele C carriers of the polymorphism COX2.8473T>C (CC 11.2 +/- 5.5 vs. CT+TT 4.4 +/- 3.5; p = 0.022; beta = 7.43; 95% CI 1.38 - 13.48). Although several differences were observed in other cell groups, they did not reach the statistical significance level. CONCLUSIONS: In patients diagnosed with sarcoidosis, there seems to be a relationship between COX2.8473 polymorphism and CD4/CD8 ratio from BAL.
Subject(s)
Bronchoalveolar Lavage Fluid/cytology , CD4-CD8 Ratio , Cyclooxygenase 2/genetics , Polymorphism, Single Nucleotide , Sarcoidosis/genetics , Adult , CD4-Positive T-Lymphocytes/enzymology , CD4-Positive T-Lymphocytes/pathology , CD8-Positive T-Lymphocytes/enzymology , CD8-Positive T-Lymphocytes/pathology , Cross-Sectional Studies , Female , Genetic Predisposition to Disease , Genotype , Humans , In Situ Hybridization, Fluorescence , Leukocytes/enzymology , Leukocytes/pathology , Macrophages, Alveolar/enzymology , Macrophages, Alveolar/pathology , Male , Middle Aged , Sarcoidosis/pathologyABSTRACT
BACKGROUND: The randomized placebo-controlled IFIGENIA-trial demonstrated that therapy with high-dose N-acetylcysteine (NAC) given for one year, added to prednisone and azathioprine, significantly ameliorates (i.e. slows down) disease progression in terms of vital capacity (VC) (+9%) and diffusing capacity (DLco) (+24%) in idiopathic pulmonary fibrosis (IPF). To better understand the clinical implications of these findings we performed additional, explorative analyses of the IFGENIA data set. METHODS: We analysed effects of NAC on VC, DLco, a composite physiologic index (CPI), and mortality in the 155 study-patients. RESULTS: In trial completers the functional indices did not change significantly with NAC, whereas most indices deteriorated with placebo; in non-completers the majority of indices worsened but decline was generally less pronounced in most indices with NAC than with placebo. Most categorical analyses of VC, DLco and CPI also showed favourable changes with NAC. The effects of NAC on VC, DLco and CPI were significantly better if the baseline CPI was 50 points or lower. CONCLUSION: This descriptive analysis confirms and extends the favourable effects of NAC on lung function in IPF and emphasizes the usefulness of VC, DLco, and the CPI for the evaluation of a therapeutic effect. Most importantly, less progressed disease as indicated by a CPI of 50 points or lower at baseline was more responsive to therapy in this study.
Subject(s)
Acetylcysteine/therapeutic use , Azathioprine/therapeutic use , Idiopathic Pulmonary Fibrosis/drug therapy , Lung/drug effects , Prednisone/therapeutic use , Respiratory System Agents/therapeutic use , Aged , Disease Progression , Double-Blind Method , Drug Therapy, Combination , Europe , Exercise Test , Female , Forced Expiratory Volume/drug effects , Humans , Idiopathic Pulmonary Fibrosis/mortality , Idiopathic Pulmonary Fibrosis/physiopathology , Lung/physiopathology , Male , Middle Aged , Patient Dropouts , Pulmonary Diffusing Capacity/drug effects , Severity of Illness Index , Time Factors , Treatment Outcome , Vital Capacity/drug effectsABSTRACT
OBJECTIVE: Study of the bronchoalveolar lavage (BAL) fluid in some interstitial lung diseases can reveal patterns typical to each disease and that can support the diagnosis. The objective of this study was to perform a descriptive analysis of the cytologic study and of the lymphocyte subpopulations in BAL fluid from patients with interstitial lung disease. MATERIAL AND METHODS: In this prospective, observational study of 562 patients between January 1991 and January 2005, BAL fluid was analyzed to determine the distribution of cell populations and of lymphocyte subsets: CD3, CD4, CD8, CD3(+)CD4(-)CD8(-), and CD56. RESULTS: The mean age was 53.4 years and 53.3% of the patients were women. The following diseases were studied: idiopathic pulmonary fibrosis (n=132), sarcoidosis (n=123), connective tissue diseases (n=133), cryptogenic organizing pneumonia (n=89), and extrinsic allergic alveolitis (n=85). Isolated lymphocytic alveolitis was common in sarcoidosis and extrinsic allergic alveolitis. Mixed alveolitis was the most common pattern in the other interstitial lung diseases. The CD4:CD8 ratio was the most useful parameter. It was high in sarcoidosis (median, 2.3); the ratio was low or inverted in the other interstitial lung diseases, with median values of 1.76 in idiopathic pulmonary fibrosis, 0.45 in extrinsic allergic alveolitis, 0.35 in cryptogenic organizing pneumonia, and 0.33 in the connective tissue diseases. CONCLUSIONS: BAL parameters, in association with clinical and radiologic data, help to discriminate between interstitial lung diseases. BAL should therefore be considered a very useful tool in clinical management, particularly when pulmonary biopsy is not conclusive or is not possible.
Subject(s)
Bronchoalveolar Lavage Fluid/cytology , Lung Diseases, Interstitial/pathology , Female , Humans , Lymphocyte Subsets , Male , Middle Aged , Prospective StudiesABSTRACT
Pulmonary alveolar proteinosis is a rare disease characterized by the accumulation of lipoproteinaceous material derived from alveolar surfactant in the alveoli, with a consequent deterioration in gas exchange. Pathogenesis is related to impaired phagocytic function of alveolar macrophages. In recent years, a new treatment for pulmonary alveolar proteinosis-consisting of subcutaneous administration of granulocyte-macrophage colony-stimulating factor (GM-CSF)-has become available. The commonly accepted treatment, and the one to have shown greatest efficacy in pulmonary alveolar proteinosis, is whole lung lavage. Instead of subcutaneous administration, GM-CSF can also be inhaled as an aerosol. This route of administration of GM-CSF is safe and effective in the treatment of pulmonary alveolar proteinosis and represents an alternative to subcutaneous administration or whole lung lavage. We present a patient with pulmonary alveolar proteinosis who was treated with inhaled GM-CSF and describe her clinical and functional outcome after 1 year of treatment.
Subject(s)
Granulocyte-Macrophage Colony-Stimulating Factor/administration & dosage , Pulmonary Alveolar Proteinosis/drug therapy , Administration, Inhalation , Adult , Female , Humans , Time FactorsABSTRACT
Objetivo:en determinadas enfermedades pulmonares intersticiales difusas (EPID), el estudio del lavado broncoalveolar (LBA) define patrones típicos de cada enfermedad y tiene valor como apoyo al diagnóstico. El objetivo del estudio ha sido realizar un análisis descriptivo del estudio citológico y de las subpoblaciones linfocitarias en el LBA efectuado a pacientes con EPID.Pacientes y métodos: estudio prospectivo de 562 pacientes con EPID desde 1991 hasta 2005. Se realizó un estudio de la distribución celular y de la subpoblaciones linfocitarias en el LBA: CD3, CD4, CD8, CD3+CD4−CD8− y CD56.Resultados:la edad media de los pacientes era de 53,4 años y el 53,3% eran mujeres. Se estudiaron las siguientes enfermedades: fibrosis pulmonar idiopática (n=132), sarcoidosis (n=123), enfermedades del colágeno (n=133), neumonía organizada criptogenética (n=89) y alveolitis alérgica extrínseca (n=85). Tanto en los casos de sarcoidosis como en los de alveolitis alérgica extrínseca fue frecuente la alveolitis linfocitaria aislada. En el resto de enfermedades la alveolitis mixta fue el patrón habitual. El índice CD4/CD8 fue el parámetro más útil, con un incremento en la sarcoidosis (mediana: 2,3). En el resto de las enfermedades el índice estaba invertido, con una mediana para la fibrosis pulmonar idiopática, la alveolitis alérgica extrínseca, la neumonía organizada criptogenética y la enfermedad del colágeno de 1,76; 0,45; 0,35, y 0,33, respectivamente.Conclusiones: los parámetros del LBA, junto a los datos clinicorradiológicos, ayudan a discriminar entre las EPID. Por lo tanto, debe considerarse una técnica de gran utilidad en el manejo clínico, sobre todo cuando la biopsia pulmonar no resulta diagnóstica o no es posible realizarla(AU)
Objective: Study of the bronchoalveolar lavage (BAL) fluid in some interstitial lung diseases can reveal patterns typical to each disease and that can support the diagnosis. The objective of this study was to perform a descriptive analysis of the cytologic study and of the lymphocyte subpopulations in BAL fluid from patients with interstitial lung disease.Material and methods: In this prospective, observational study of 562 patients between January 1991 and January 2005, BAL fluid was analyzed to determine the distribution of cell populations and of lymphocyte subsets: CD3, CD4, CD8, CD3+CD4−CD8−, and CD56.ResultsThe mean age was 53.4 years and 53.3% of the patients were women. The following diseases were studied: idiopathic pulmonary fibrosis (n=132), sarcoidosis (n=123), connective tissue diseases (n=133), cryptogenic organizing pneumonia (n=89), and extrinsic allergic alveolitis (n=85). Isolated lymphocytic alveolitis was common in sarcoidosis and extrinsic allergic alveolitis. Mixed alveolitis was the most common pattern in the other interstitial lung diseases. The CD4:CD8 ratio was the most useful parameter. It was high in sarcoidosis (median, 2.3); the ratio was low or inverted in the other interstitial lung diseases, with median values of 1.76 in idiopathic pulmonary fibrosis, 0.45 in extrinsic allergic alveolitis, 0.35 in cryptogenic organizing pneumonia, and 0.33 in the connective tissue diseases.Conclusions: BAL parameters, in association with clinical and radiologic data, help to discriminate between interstitial lung diseases. BAL should therefore be considered a very useful tool in clinical management, particularly when pulmonary biopsy is not conclusive or is not possible(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Bronchoalveolar Lavage Fluid/cytology , Lung Diseases, Interstitial/pathology , Lymphocyte Subsets , Prospective StudiesABSTRACT
La proteinosis alveolar pulmonar (PAP) es una rara enfermedad que se caracteriza por la acumulación en el alvéolo pulmonar de un material lipoproteico derivado del surfactante alveolar, lo que provoca el consiguiente deterioro del intercambio gaseoso. Su patogenia está relacionada con alteraciones en la capacidad fagocítica del macrófago alveolar. Desde hace pocos años existe un nuevo tratamiento para la PAP consistente en la administración de factor estimulante de colonias de granulocitos y macrófagos (GM-CSF) por vía subcutánea. El tratamiento comúnmente aceptado y que ha demostrado mayor eficacia en la PAP es el lavado pulmonar total. Una alternativa a este tratamiento es la administración por vía inhalada en aerosolterapia de este factor. La administración del GM-CSF por vía inhalada es segura y eficaz para el tratamiento de la PAP y supone una alternativa al tratamiento con lavado pulmonar total y GM-CSF por vía subcutánea. Presentamos un caso de PAP tratada con GM-CSF por vía inhalada y su evolución clínica y funcional tras un año de tratamiento(AU)
Pulmonary alveolar proteinosis is a rare disease characterized by the accumulation of lipoproteinaceous material derived from alveolar surfactant in the alveoli, with a consequent deterioration in gas exchange. Pathogenesis is related to impaired phagocytic function of alveolar macrophages. In recent years, a new treatment for pulmonary alveolar proteinosisconsisting of subcutaneous administration of granulocyte-macrophage colony-stimulating factor (GM-CSF)has become available. The commonly accepted treatment, and the one to have shown greatest efficacy in pulmonary alveolar proteinosis, is whole lung lavage. Instead of subcutaneous administration, GM-CSF can also be inhaled as an aerosol. This route of administration of GM-CSF is safe and effective in the treatment of pulmonary alveolar proteinosis and represents an alternative to subcutaneous administration or whole lung lavage. We present a patient with pulmonary alveolar proteinosis who was treated with inhaled GM-CSF and describe her clinical and functional outcome after 1 year of treatment(AU)
Subject(s)
Humans , Female , Adult , Granulocyte-Macrophage Colony-Stimulating Factor/administration & dosage , Pulmonary Alveolar Proteinosis/drug therapy , Administration, Inhalation , Time FactorsABSTRACT
BACKGROUND: Malignant pleural mesothelioma (MPM) results from malignant transformation of mesothelial cells. Past asbestos exposure represents a major risk factor for MPM and other benign pleural disease. Soluble mesothelin-related peptides (SMRP) have been regarded as a promising serum biomarker for MPM. The aim of this study was to investigate serum levels of SMRP in malignant and nonmalignant asbestos-related pleural disease. PATIENTS: Four groups of patients were investigated: group 1 composed of 48 healthy subjects, group 2 composed of 177 patients with previous asbestos exposure and no pleural disease, group 3 composed of 36 patients with MPM, and group 4 composed of 101 patients with previous asbestos exposure and benign pleural disease. Serum SMRP levels were determined by ELISA. RESULTS: Serum SMRP levels were significantly higher among group 3 than the other three groups. There were no differences in SMRP concentrations between groups 2 and 4. Subjects exposed to asbestos had higher SMRP concentrations than normal control subjects regardless of the presence of pleural disease. The area under the receiver operating characteristic curve for SMRP values was 0.75 (95% confidence interval, 0.68-0.83). The SMRP level at 0.55 nmol/L/L was determined as the most optimal cutoff value with resulting sensitivity and specificity of 72% and 72% for the diagnosis of MPM. CONCLUSIONS: These data attest to good diagnostic sensitivity and specificity of SMRP for the diagnosis of malignant mesothelioma. We have also shown that serum SMRP levels might serve as a marker of asbestos exposure.
Subject(s)
Asbestosis/blood , Biomarkers, Tumor/blood , Membrane Glycoproteins/blood , Mesothelioma/blood , Pleural Neoplasms/blood , Adult , Area Under Curve , Cross-Sectional Studies , Enzyme-Linked Immunosorbent Assay , Female , GPI-Linked Proteins , Humans , Male , Mesothelin , Mesothelioma/chemically induced , Middle Aged , Pleural Neoplasms/chemically induced , Prospective Studies , ROC Curve , Statistics, NonparametricABSTRACT
BACKGROUND: The aim of this multicenter study was to investigate the relationship between single nucleotide polymorphisms (SNPs) of the cyclooxygenase-2 (COX2) gene and susceptibility to sarcoidosis, as well as the relation between these SNPs and the evolution of the disease. MATERIAL AND METHODS: This multicenter investigation involved seven hospitals in Spain. We used a case-control design followed by a prospective follow-up study. Sarcoid patients were recruited from the participating institutions during outpatient routine visits. Age- and gender-matched control subjects were recruited mainly from among outpatients attending the participating hospitals. Four SNPs in the COX2 gene (COX2.5909 T > G, COX2.8473 T > C, COX2.926 G > C, and COX2.3050 G > C) were genotyped using fluorescent hybridization probes among 131 patients with sarcoidosis (63 males; mean age: 47 +/- 15 years) and 157 healthy controls (83 males; mean age: 50 +/- 16 years). We employed a binomial multiple logistic regression analysis to test the association between the selected SNPs and disease susceptibility. The clinical, functional and radiological prognosis of the sarcoidosis patients was determined after a mean follow-up of 37.4 +/- 30.4 months. RESULTS: Carriers of the homozygous CC genotype of the COX2.8473 T > C polymorphism had a higher risk of sarcoidosis compared with TT carriers (OR: 3.08; 95% CI: 1.2-7.7; p = 0.035). 84% of patients achieved improvement or complete remission at follow-up. No association between the investigated SNPs and prognosis was seen. CONCLUSIONS: Our data suggest that the homozygous CC genotype of the COX2.8473 T > C polymorphism may be associated with sarcoidosis susceptibility. No significant association with prognosis was detected.
Subject(s)
Cyclooxygenase 2/genetics , Polymorphism, Single Nucleotide , Sarcoidosis, Pulmonary/genetics , Adult , Alleles , Base Sequence , Case-Control Studies , Chi-Square Distribution , DNA Primers , Disease Progression , Female , Follow-Up Studies , Gene Frequency , Genetic Predisposition to Disease , Genotype , Humans , Lung/diagnostic imaging , Male , Middle Aged , Molecular Sequence Data , Prognosis , Proportional Hazards Models , Prospective Studies , Radiography , Sarcoidosis, Pulmonary/diagnostic imagingABSTRACT
Among the idiopathic interstitial lung diseases, respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) and desquamative interstitial pneumonia (DIP) make up a subgroup of rare diseases that are clearly smoking related. Few large case series have been published. We describe 19 cases registered in Spain: 12 patients with DIP and 7 with RB-ILD. Clinical and radiologic features are described along with clinical course, treatments applied, and outcomes. With the exception of 2 patients with DIP, all were smokers or ex-smokers. Cough and dyspnea were the most common symptoms at onset in both diseases. The most frequent radiologic findings were ground-glass opacity in DIP and pulmonary nodules in BR-ILD. Most patients were treated with corticosteroids. Outcomes were good in general; only 1 patient, with DIP, died.
Subject(s)
Bronchiolitis , Lung Diseases, Interstitial , Registries , Bronchiolitis/diagnosis , Bronchiolitis/drug therapy , Female , Humans , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/drug therapy , Male , Middle Aged , SpainABSTRACT
Dentro de las neumopatías intersticiales idiopáticas, la bronquiolitis respiratoria asociada a enfermedad pulmonar intersticial (BR-EPI) y la neumonía intersticial descamativa (NID) forman un subgrupo de enfermedades raras que comparten una relación clara con el hábito tabáquico. Se han publicado pocas series con un número importante de pacientes. En este trabajo se describen las características de 19 casos (12 con NID y 7 con BR-EPI) recogidos en nuestro país. Se detallan las características clínicas, radiológicas y evolutivas, incluidos los tratamientos empleados y sus resultados. Excepto 2 pacientes con NID, todos eran o habían sido fumadores. Tos y disnea fueron los síntomas de inicio más frecuentes, sin diferencias entre las 2 enfermedades. La alteración radiológica predominante en la NID fue el patrón en vidrio deslustrado, y en la BR-EPI, la presencia de nódulos pulmonares. La mayor parte de los pacientes recibieron tratamiento con esteroides. El pronóstico en general fue bueno, y falleció únicamente un paciente con NID
Among the idiopathic interstitial lung diseases, respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) and desquamative interstitial pneumonia (DIP) make up a subgroup of rare diseases that are clearly smoking related. Few large case series have been published. We describe 19 cases registered in Spain: 12 patients with DIP and 7 with RB-ILD. Clinical and radiologic features are described along with clinical course, treatments applied, and outcomes. With the exception of 2 patients with DIP, all were smokers or ex-smokers. Cough and dyspnea were the most common symptoms at onset in both diseases. The most frequent radiologic findings were ground-glass opacity in DIP and pulmonary nodules in BR-ILD. Most patients were treated with corticosteroids. Outcomes were good in general; only 1 patient, with DIP, died
Subject(s)
Humans , Male , Female , Middle Aged , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/diagnosis , Bronchiolitis/complications , Cryptogenic Organizing Pneumonia/complications , Tobacco Use Disorder/epidemiology , Tobacco Use Disorder/pathology , Biopsy/methods , Radiography, Thoracic/methods , Lung Diseases, Interstitial/epidemiology , Lung Diseases, Interstitial/physiopathology , Signs and Symptoms , Steroids/therapeutic useABSTRACT
BACKGROUND AND OBJECTIVE: To describe the characteristics observed in patients diagnosed of hepatopulmonary syndrome (HPS) waiting for orthotopic liver transplantation and those who underwent liver trasplantation. PATIENTS AND METHOD: An observational prospective descriptive study was carried out of patients waiting for liver transplantation in whom data of liver illness and lung function tests were analyzed. RESULTS: 107 patients of 53.69 years average age were studied (7.7 standard deviation). 24 of them (22.4%) had criteria of HPS. Ortodeoxia was present in the 34% of cases. The lung function tests were normal. In the comparative study between patients with HPS and no HPS, differences in diffusion were found (7.1 vs. 8.6 mmol/min/kPa; p = 0.04), as well as in the shunt (8% vs. 5.3%; p = 0.05) and the forced expiratory volume in one second (2,390 vs. 2,743 ml; p = 0.03). Seven patients were transplanted with correction of oxygenation and vascular dilatations in all of them. CONCLUSIONS: HPS is a frequent illness in patients waiting for orthotopic liver transplantation. The main alteration in the blood oxygenation seems owe to shunt, and the diffusion tests is the analysis that could best differentiate patients with HPS. Orthotopic liver transplantation corrects the syndrome in all cases.
Subject(s)
Hepatopulmonary Syndrome , Liver Cirrhosis/complications , Liver Transplantation , Female , Hepatopulmonary Syndrome/diagnosis , Hepatopulmonary Syndrome/etiology , Hepatopulmonary Syndrome/physiopathology , Hepatopulmonary Syndrome/surgery , Humans , Liver Cirrhosis/diagnosis , Male , Middle Aged , Prospective Studies , Respiratory Function TestsABSTRACT
Fundamento y objetivo: Describir las características clínicas y funcionales de pacientes con síndrome hepatopulmonar (SHP) en lista de espera para trasplante ortotópico hepático y los cambios producidos en ellas en un grupo de pacientes que recibió el trasplante. Pacientes y método: Se ha realizado un estudio observacional, transversal y descriptivo con carácter prospectivo de pacientes en lista de espera para trasplante hepático, en quienes se analizaron datos de enfermedad hepática y de pruebas de función respiratoria. Resultados: Se ha estudiado a 107 pacientes, con una edad media (desviación estándar) de 53,69 (7,7) años, de los que 24 (22,4%) cumplían criterios de SHP. La ortodesoxia estaba presente en el 34% de los pacientes. Las pruebas de función respiratoria estaban dentro de la normalidad. En el estudio comparativo entre los pacientes afectados de SHP y el resto se encontraron diferencias en la difusión de monóxido de carbono (7,1 frente a 8,6 mmol/min/kPa; p = 0,04), la cuantía del cortocircuito pulmonar (un 8 frente al 5,3%; p = 0,05) y el volumen espiratorio forzado en el primer segundo (2.390 frente a 2.743 ml; p = 0,03). En 7 pacientes con SHP que recibieron el trasplante se corrigieron la oxigenación y las dilataciones vasculares. Conclusiones: El SHP es una entidad frecuente en pacientes en espera de trasplante ortotópico hepático. La principal alteración en la oxigenación sanguínea parece ser debida al efecto cortocircuito. Las pruebas de difusión de monóxido de carbono son las que parecen tener mayor carácter discriminativo entre los pacientes con y sin SHP. Tras el trasplante desaparece el síndrome en todos los pacientes
Background and objective: To describe the characteristics observed in patients diagnosed of hepatopulmonary syndrome (HPS) waiting for orthotopic liver transplantation and those who underwent liver trasplantation. Patients and method: An observational prospective descriptive study was carried out of patients waiting for liver transplantation in whom data of liver illness and lung function tests were analyzed. Results: 107 patients of 53.69 years average age were studied (7.7 standard deviation). 24 of them (22.4%) had criteria of HPS. Ortodeoxia was present in the 34% of cases. The lung function tests were normal. In the comparative study between patients with HPS and no HPS, differences in diffusion were found (7.1 vs. 8.6 mmol/min/kPa; p = 0.04), as well as in the shunt (8% vs. 5.3%; p = 0.05) and the forced expiratory volume in one second (2,390 vs. 2,743 ml; p = 0.03). Seven patients were transplanted with correction of oxygenation and vascular dilatations in all of them. Conclusions: HPS is a frequent illness in patients waiting for orthotopic liver transplantation. The main alteration in the blood oxygenation seems owe to shunt, and the diffusion tests is the analysis that could best differentiate patients with HPS. Orthotopic liver transplantation corrects the syndrome in all cases
Subject(s)
Humans , Hepatopulmonary Syndrome/physiopathology , Liver Cirrhosis/physiopathology , Vasodilation/physiology , Hypertension, Portal/physiopathology , Liver Cirrhosis/complications , Liver Transplantation , Cross-Sectional StudiesABSTRACT
BACKGROUND: Idiopathic pulmonary fibrosis is a chronic progressive disorder with a poor prognosis. METHODS: We conducted a double-blind, randomized, placebo-controlled multicenter study that assessed the effectiveness over one year of a high oral dose of acetylcysteine (600 mg three times daily) added to standard therapy with prednisone plus azathioprine. The primary end points were changes between baseline and month 12 in vital capacity and in single-breath carbon monoxide diffusing capacity (DL(CO)). RESULTS: A total of 182 patients were randomly assigned to treatment (92 to acetylcysteine and 90 to placebo). Of these patients, 155 (80 assigned to acetylcysteine and 75 to placebo) had usual interstitial pneumonia, as confirmed by high-resolution computed tomography and histologic findings reviewed by expert committees, and did not withdraw consent before the start of treatment. Fifty-seven of the 80 patients taking acetylcysteine (71 percent) and 51 of the 75 patients taking placebo (68 percent) completed one year of treatment. Acetylcysteine slowed the deterioration of vital capacity and DL(CO): at 12 months, the absolute differences in the change from baseline between patients taking acetylcysteine and those taking placebo were 0.18 liter (95 percent confidence interval, 0.03 to 0.32), or a relative difference of 9 percent, for vital capacity (P=0.02), and 0.75 mmol per minute per kilopascal (95 percent confidence interval, 0.27 to 1.23), or 24 percent, for DL(CO) (P=0.003). Mortality during the study was 9 percent among patients taking acetylcysteine and 11 percent among those taking placebo (P=0.69). There were no significant differences in the type or severity of adverse events between patients taking acetylcysteine and those taking placebo, except for a significantly lower rate of myelotoxic effects in the group taking acetylcysteine (P=0.03). CONCLUSIONS: Therapy with acetylcysteine at a dose of 600 mg three times daily, added to prednisone and azathioprine, preserves vital capacity and DL(CO) in patients with idiopathic pulmonary fibrosis better than does standard therapy alone.
Subject(s)
Acetylcysteine/administration & dosage , Antioxidants/administration & dosage , Pulmonary Fibrosis/drug therapy , Acetylcysteine/adverse effects , Acetylcysteine/pharmacology , Aged , Anti-Inflammatory Agents/therapeutic use , Antioxidants/adverse effects , Antioxidants/pharmacology , Azathioprine/therapeutic use , Double-Blind Method , Drug Therapy, Combination , Exercise Tolerance/drug effects , Female , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Prednisone/therapeutic use , Pulmonary Diffusing Capacity/drug effects , Pulmonary Fibrosis/mortality , Pulmonary Fibrosis/physiopathology , Vital Capacity/drug effectsABSTRACT
UNLABELLED: This study aims to describe the distribution of interstitial lung diseases (ILD) in the South of Spain. METHODS: A prospective multicentre population-based registry was established in nine provinces in the south of Spain with a population of 6,848,243 during a 3-year period (1998-2000). The number of participant physicians was 36 among 29 public hospitals. The number of diagnoses recorded was 66, divided in eight categories and coded according to ICD-9. A consensus document was elaborated for the classification of diseases and their diagnostic criteria. The number of cases declared was analysed each 3 months and communicated to each one of the participants. RESULTS: There were 744 cases of them registered with an annual incidence of 3.62 cases/ 100,000. 40.1% of diagnoses were biopsy confirmed. Men had a slightly higher incidence (4.18 cases/ 100,000/year) than women (3.07 cases/100,000/year). The most frequent diseases found were: idiopathic interstitial pneumonias (38.58%), ILD associated to systemic diseases (20.97%), and Sarcoidosis (11.69%). According to province distribution, most of the cases were grouped in an area between the provinces of Seville and Cordoba, which comprised more than 50% of cases. CONCLUSIONS: The study of the incidence of ILD depicts an intermediate situation from previous studies on the incidence and distribution of this group of diseases.
Subject(s)
Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/epidemiology , Age Distribution , Aged , Aged, 80 and over , Biopsy, Needle , Female , Humans , Incidence , Male , Middle Aged , Population Surveillance , Prospective Studies , Respiratory Function Tests , Risk Factors , Severity of Illness Index , Sex Distribution , Spain/epidemiology , Survival AnalysisABSTRACT
Transforming growth factor-beta1 (TGF-beta1) is a cytokine that plays a key role in the development of idiopathic pulmonary fibrosis. There have been reports on the presence of two genetic polymorphisms in the DNA sequence encoding the leader sequence of the TGF-beta1 protein, located in codons 10 and 25. The objective of this study was to investigate the association between TGF-beta1 gene polymorphisms in codons 10 and 25 and the susceptibility to idiopathic pulmonary fibrosis and the progression of the disease. Compared with healthy control subjects (n = 140), patients with idiopathic pulmonary fibrosis (n = 128) showed no significant deviations in genotype or allele frequencies. One hundred and ten patients with idiopathic pulmonary fibrosis were followed up for 30.3 +/- 25 months. The presence of a proline allele at codon 10 was independently associated with a significant increase in alveolar arterial oxygen tension difference during follow-up, after controlling for the effect of treatment (coefficient = 0.59; 95% confidence intervals, 0.23 to 0.96; p = 0.002). These findings suggest that (1) TGF-beta1 gene polymorphisms in codons 10 and 25 do not predispose to the development of idiopathic pulmonary fibrosis; and (2) TGF-beta1 gene polymorphisms may affect disease progression in patients with idiopathic pulmonary fibrosis.
Subject(s)
Polymorphism, Genetic/genetics , Pulmonary Fibrosis/genetics , Transforming Growth Factor beta/genetics , Adult , Aged , Base Sequence/genetics , Chi-Square Distribution , Codon/genetics , Confidence Intervals , Disease Progression , Female , Follow-Up Studies , Gene Frequency/genetics , Genotype , Humans , Linear Models , Male , Oxygen/blood , Proline/genetics , Pulmonary Alveoli/metabolism , Pulmonary Fibrosis/drug therapy , Transforming Growth Factor beta1ABSTRACT
BACKGROUND: Recent publications have suggested that neutrophil elastase (NE) may have a role in evaluating the clinical condition of patients with interstitial lung diseases (ILD). This study aims to evaluate the role of serum NE levels in the follow-up of patients with ILD. MATERIAL/METHODS: A group of 100 consecutive patients diagnosed with various ILDs were prospectively studied on two successive visits. On the first visit, the clinical condition of each patient was assessed, and blood count, pulmonary function tests, chest x-ray and serum NE levels (by latex agglutination assay) were performed on all patients. On the second visit, 8 months later, the patients were classified in two groups: those with unfavorable progression and those who were either in the same clinical status or showed good progression. RESULTS: There was a weak correlation between NE and age (r= -0.383; p < 0.0005). Sex, age, NE and the treatment received were found to be independent predictors of the initial clinical condition. Multivariate analysis including these variables demonstrated that higher levels of serum NE predicted the worst clinical presentation (odds ratio: 4.392; 95% CI: 1.665 - 11.586; p = 0.003). However, none of the variables were found to be significantly different when the progression of the disease was assessed. CONCLUSIONS: Although NE seems to be a good marker for the initial clinical condition in this group of diseases, its role as a prognostic factor could not be proven
