ABSTRACT
UNLABELLED: Assessment of CEA concentration, levels of the antibodies against mycobacterial antigens A60 and 38 kDa and ACE activity in serum and in BALF of the patients with sarcoidosis (n = 8), tuberculosis (n = 13) and lung cancer (n = 10) was performed. Nine healthy volunteers were referred to as the control group. Sarcoidosis and lung cancer were confirmed histopathologically. Diagnosis of tuberculosis was stated using the radiometric Bactec 460 system. Serum and BALF CEA concentration and IgG levels against A-60 and 38 kDa were measured by ELISA: IMx, Immunozym and Pathozyme, respectively. ACE activity was assayed by the spectrophotometric method. Statistically significant (p < 0.01) increase in BALF-ACE activity in patients with sarcoidosis compared to each group was observed. Serum level of antibodies against 38 kDa and serum ACE activity were specific for tuberculosis and sarcoidosis respectively, but their sensitivity were very poor. Serum CEA concentration was fairly specific for lung cancer but its sensitivity was not satisfactory. CONCLUSIONS: 1. Determination of BALF-ACE activity may be helpful in diagnosis of sarcoidosis but it is recommended to continue the study on more numerous groups of patients taking into consideration polymorphism in the ACE gene. 2. High level of antibodies against 38 kDa and ACE activity in serum are specific for tuberculosis and sarcoidosis respectively but both tests have restricted application because of their poor sensitivity. 3. Serum CEA concentration could be considered only as an auxiliary test in the diagnosis of lung cancer.
Subject(s)
Antibodies, Bacterial/analysis , Carcinoembryonic Antigen/analysis , Lung Neoplasms/diagnosis , Peptidyl-Dipeptidase A/analysis , Sarcoidosis/diagnosis , Tuberculosis/diagnosis , Adult , Biomarkers/analysis , Bronchoalveolar Lavage Fluid/chemistry , Humans , Lung Neoplasms/blood , Middle Aged , Mycobacteriaceae/immunology , Peptidyl-Dipeptidase A/genetics , Polymorphism, Genetic , Sarcoidosis/blood , Sensitivity and Specificity , Tuberculosis/bloodABSTRACT
Low-dose methotrexate therapy has been recently proposed as an alternative therapy for patients with severe steroid-dependent asthma. This study examined the role of low-dose methotrexate in the management of asthma. Fourteen subjects with stable, severe asthma were enrolled. Patients received orally methotrexate 15 mg/week. Only 2 of 14 patients responded to methotrexate 2 to 3 years after the study's termination. The doses of steroids could be reduced. Side effects were observed in nearly 50% of patients; 7 subjects required the discontinuation of treatment. Low-dose methotrexate therapy may have probably a role in small selected group of steroid-dependent asthmatics.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Asthma/drug therapy , Enzyme Inhibitors/adverse effects , Methotrexate/adverse effects , Adult , Aged , Asthma/diagnosis , Dose-Response Relationship, Drug , Female , Humans , Male , Middle Aged , Severity of Illness Index , Steroids , Treatment OutcomeABSTRACT
SETTING: The ELISA test is generally accepted for serodiagnosis of tuberculosis. Its sensitivity and specificity depend on the antigen used and data are not always concordant. In some patients suspected of tuberculosis, sarcoidosis or lung cancer, bronchoalveolar lavage (BAL) is performed. BAL fluid (BALF) contains immunoglobulins--their source is transudation from the serum but local IgG synthesis of IgG is not excluded. OBJECTIVE: The comparison of BALF versus serum in the serodiagnosis of pulmonary tuberculosis, and its differentiation from sarcoidosis and lung cancer. DESIGN: The IgG against A60 and 38 kDa antigens in serum and BALF were measured using the commercially available IgG EIA kits. The study included 13 tuberculous patients, 8 patients with sarcoidosis, 10 patients with lung cancer and 9 healthy volunteers. RESULTS: In the serum studies the sensitivity of the assays did not exceed 40% and 60% in the estimation of IgG 38 kDa and IgG A60, respectively. The specificity of both assays was similar: 81% (IgG 38 kDa) and 69-75% (IgG A60). In BALF studies the sensitivity of the IgG 38 kDa assay was 50% and its specificity was 44%. The ranges of the IgG A60 concentrations in BALF were similar in all subject groups. CONCLUSION: In differentiation between tuberculosis, sarcoidosis and lung cancer, the measurement of IgG against A60 and 38 kDa antigens in serum is more useful than that in BALF.
Subject(s)
Antigens, Bacterial/immunology , Bronchoalveolar Lavage Fluid/immunology , Immunoglobulin G/analysis , Lipoproteins , Tuberculosis, Pulmonary/diagnosis , Adult , Carcinoma, Non-Small-Cell Lung/diagnosis , Diagnosis, Differential , Humans , Immunoenzyme Techniques , Immunoglobulin G/blood , Lung Neoplasms/diagnosis , Middle Aged , Sarcoidosis, Pulmonary/diagnosis , Sensitivity and Specificity , Serologic TestsABSTRACT
Thromboxane B2 (TxB2) is believed to play some role in pathogenesis of interstitial pulmonary diseases. The concentration of TxB2 in BALF was assayed in 75 ill and 6 healthy persons. The ill were divided into 6 groups: with active sarcoidosis [18], with active sarcoidosis treated with corticosteroids [8], with advanced pulmonary fibrosis [15], with moderate pulmonary fibrosis [6], with avian fanciers lung after exposition of antigen [16], avian fanciers lung without exposition of antigen [13]. Radioimmunological method with the Amersham set to assay the concentration of TxB, was used. A rise of TxB2 concentration was detected in the group with advanced pulmonary fibrosis. The rise was significant compared with the group of healthy persons, those with sarcoidosis, and with moderate pulmonary fibrosis. A tendency to higher concentration of TxB2 in patients with avian fanciers lung exposed to the allergen was also observed. The results indicate that TxB2 takes part in pathogenesis of these interstitial pulmonary diseases in which increased number of neutrophils in BALF is found.
Subject(s)
Bronchoalveolar Lavage Fluid/chemistry , Lung Diseases, Interstitial/physiopathology , Thromboxane B2/analysis , Adult , Aged , Bronchoalveolar Lavage Fluid/cytology , Case-Control Studies , Female , Humans , Leukocyte Count , Male , Middle Aged , Neutrophils , Radioimmunoassay , Smoking/physiopathologyABSTRACT
The case of a 57 year old male with Wegener's granulomatosis is reported in whom the course of cyclophosphamide and prednisone treatment a subacute mycobacterial tuberculosis pneumonia evolved. The diagnosis was based on culture of Mycobacterium tuberculosis organisms from the bronchoalveolar lavage fluid. The authors discuss the role of bronchoscopy and bronchoalveolar lavage in the diagnosis of pulmonary tuberculosis.