[Efficacy of bronchoscopic Nd:YAG laser therapy for laryngotracheal stenoses after long-term intubation]. / Zur Effizienz der bronchoskopischen Nd:YAG-Lasertherapie für laryngotracheale Stenosen nach Langzeitintubation.

From 1987 to 1993, 38 patients with laryngotracheal stenosis due to prolonged intubation were treated with the Nd:YAG-laser. A total of 45 stenoses were identified and classified according to endoscopic assessment. Patients who had an asymptomatic airway for at least 8 months and did not require further intervention were considered treatment successes. The best results were found in the diaphragmas and granulomas (86% and 65%), in stenoses less than 1 cm in length (61%) and in cases with less than 70% obstruction of the tracheal lumen (61%).

Bronchoalveolar lavage in the diagnosis of disseminated lung tumors.

We report our experience with bronchoalveolar lavage (BAL) and its value in the diagnosis of malignant lung infiltrates. A total of 162 patients with biopsy- or autopsy-proven cancer had an analysis of BAL fluid performed. Cytologic examination showed malignant cells in 123 (76%) patients. The diagnostic accuracy varied depending on the neoplastic nature and growth pattern of the disease. BAL disclosed cancer cells in 93% of 44 bronchioloalveolar carcinomas. Carcinomatous lymphangitis due to metastatic cancer was diagnosed in 83% of 69 cases. Hematogenous metastases (with sharply circumscribed nodules on chest radiography) were diagnosed in 45% of 22 such cases. We recognized 67% of 15 non-Hodgkin's lymphomas and 3 of 9 cases of Hodgkin's disease with pulmonary involvement. Immunocytochemistry using monoclonal and/or polyclonal antibodies was of value in the identification and classification of cells in non-Hodgkin's lymphoma.

Acute lung inflammation: neutrophil elastase versus neutrophils in the bronchoalveolar lavage--neutrophil elastase reflects better inflammatory intensity.

OBJECTIVE: To test the hypothesis whether PMN-Elastase in bronchoalveolar lavage fluid (BALF) could reflect neutrophil activity in the lower respiratory tract. DESIGN: Prospectively, morphologic findings of acute and chronic inflammation in the transbronchial lung biopsy specimens were compared with the numbers of neutrophils in the BALF and the concentration of PMN-Elastase in the same. SETTING: Ambulatory outpatient service of bronchology and respiratory physiopathology and intensive care unit of a communal hospital. PATIENTS: 50 ambulatory outpatients and 10 critically ill patients of the ICU, presenting infiltrative lung diseases. INTERVENTIONS: Transbronchial lung biopsies and bronchoalveolar lavage were performed through a fiberoptic bronchoscope. Venous blood samples were obtained after bronchoscopy. MEASUREMENTS AND RESULTS: Biopsy specimens and cell count in the BALF were examined by light microscopy. PMN-Elastase and albumin were measured in the BALF-supernatant and in the plasma. C-reactive protein (CRP) and a1 proteinase inhibitor (a1-PI) were measured in the plasma. Intrapulmonary originating PMN-Elastase was calculated with reference to albumin. The results concerning acute inflammation obtained by transbronchial lung biopsy (TBLB) (n = 16) correlated better with the levels of PMN-Elastase in the BALF (n = 21) than with the neutrophil count (n = 28) (p < 0.5 versus p < 0.025 for chi 2). The sensitivities and specificities of the above methods were respectively 76.9%, 100%, 100% and 100%, 95.2%, 63.1%. The intrapulmonary originating PMN-Elastase was about 99.7% of the measured BALF-Elastase. CONCLUSION: The PMN-Elastase concentration in the BALF is a more accurate indicator of the inflammatory intensity in the alveolar structures than in the number of neutrophils. It may therefore be useful to the clinician in his attempt to detect acute inflammation in the lower respiratory tract.

[Unilateral gynecomastia induced by the use of anabolic steroids. A clinical case report]. / Ginecomastia unilaterale indotta dall'uso di steroidi anabolizzanti. Descrizione di un caso clinico.

The authors studied a case of left unilateral gynecomastia occurring in a 26-year-old body-builder after anabolic steroids assumption. The mammal features were found by echography and mammography and they showed the presence of a 3 cm diameter retroareolar area of gland tissue surrounded by fibrotic tissue. After excluding every likely cause giving gynecomastia through laboratory tests, it was clear a relationship with the assumption of high doses of anabolic hormones, with particular regard to methyltestosterone. Therefore, also this substance which on its own is not aromatized by extrasplanchnic tissues, can be responsible for man's mammal hypertrophy, if joined to a slight iatrogenic liver cytolysis.

Diffuse panbronchiolitis observed in an Italian male.

We describe a case of a 43 year old man who presented with productive cough, dyspnea, severe obstructive ventilatory failure and diffuse micronodular shadows on chest roentgenogram. Bronchoalveolar lavage fluid analysis showed an increased total cellularity sustained by a huge neutrophilia. Sweat test was negative. Transbronchial lung biopsy and autopsy showed unit lesion of diffuse panbronchiolitis. This report represents, to the best of our knowledge, the first case of diffuse panbronchiolitis observed in Europe.

Prognostic significance of the evaluation of bronchoalveolar lavage cell populations in patients with HIV-1 infection and pulmonary involvement.

To investigate the prognostic utility of the morphologic and immunologic evaluation of BAL cell populations in determining mortality risk, we analyzed BAL data obtained from 115 patients infected with HIV-1. Forty fatal outcomes occurred within 73 patients with OI. The OI patients who died showed a significant increase in neutrophils with respect to surviving patients. Furthermore, the finding of a BAL neutrophilia in HIV-1-infected patients with OI strongly correlated with a high risk of death. Among 42 cases without OI, 11 patients died. Patients without OI who had a fatal outcome showed an increase in CD3+ and CD8+ BAL lymphocytes with respect to the survivors. The presence of a lymphocytic alveolitis was associated with a significant increase in the mortality rate. Taken together our data suggest that the evaluation of the BAL cell populations might be useful in predicting the risk of fatal outcome in patients with HIV-1 infection.

Alveolar macrophages from patients with AIDS and AIDS-related complex constitutively synthesize and release tumor necrosis factor alpha.

To verify the hypothesis that alveolar macrophages (AMs) from patients infected with HIV-1 could synthesize and release TNF alpha, AMs recovered from the BAL fluid of 11 patients with seropositive HIV-1 (six with AIDS and five with ARC) were tested in vitro for their ability to destroy TNF alpha-susceptible targets. Furthermore, the presence of TNF alpha was assessed in AM-conditioned supernatants on the basis of their cytotoxic activity and by using an immunoenzymatic test and immunoblotting. Transcription of the TNF alpha gene in AMs was also studied by means of the Northern blot analysis. AMs freshly recovered from patients infected with HIV-1 exhibited high levels of cell-mediated cytotoxicity against U937 targets, and the addition of a polyclonal anti-TNF alpha antibody resulted in a significant inhibition of the target lysis. Cell-free supernatants conditioned by unstimulated AMs exerted high levels of cytotoxic activity against TNF alpha-sensitive targets, whereas duplicate, neutralization experiments performed in the presence of an anti-TNF alpha antibody proved that the observed cytotoxic activity was mostly mediated by TNF alpha. The presence of high amounts of TNF alpha in the conditioned media was confirmed by the immunoenzymatic test. In addition, the immunoblot analysis showed that the TNF alpha released by AMs has a Mr 17,000 band, identical to a standard preparation of recombinant TNF alpha. The Northern blot demonstrated that unstimulated AMs express detectable levels of mRNA transcripts for TNF alpha. Taken together, our data support the concept that AMs from patients with HIV-1 infection constitutively release TNF alpha.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytotoxic events taking place in the lung of patients with HIV-1 infection. Evidence of an intrinsic defect of the major histocompatibility complex-unrestricted killing partially restored by the incubation with rIL-2.

To characterize the cytotoxic events taking place in the lung of patients with HIV-1 infection, we studied the cells recovered from the bronchoalveolar lavage (BAL) of nine patients with AIDS, seven patients with AIDS-related complex, and two patients with lymphadenopathy. Phenotypic analysis was coupled to a series of functional evaluations of nonspecific cytotoxic abilities performed on lung effectors, including their property to bind K-562 targets, to release natural killer cytotoxic factor (NKCF), and to become cytotoxic following in vitro activation with rIL-2. Our results demonstrated that lung cells bearing the NK-related CD16, CD56, and CD57 antigens were quantitatively increased, irrespective of the disease stage. The majority of the cells also coexpressed the CD3 molecule and the alpha/beta T cell receptor (TCR), notably the phenotype characterizing MHC-unrestricted cytotoxic T cells. From a functional point of view, a severe impairment of the spontaneous cytotoxic ability was demonstrated in most patients. Evaluation at the single cell level showed a normal percentage of the effector/target conjugates formed by HIV-1 lymphocytes. The release of NKCF was undetectable in patients with AIDS even following lectin stimulation, whereas BAL cells from patients with earlier infection produced and/or could be triggered to release discrete amounts of NKCF by incubation with PHA. Studies designed to activate lung cytotoxic cells with rIL-2 showed that in most patients the stimulation of effector cells with rIL-2 enhanced the spontaneous killing and elicited a lymphokine-activated killer (LAK) phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)

[A comparative evaluation of computerized diagnostic decisional support in gastroenterology in relation to typical clinical pictures]. / Valutazione comparativa di un supporto decisionale diagnostico computerizzato in gastroenterologia in rapporto alla tipicità dei quadri clinici.

On the basis of the results obtained in a previous perspective comparative study aimed to compare the diagnostic accuracy of a computerized diagnostic decisional support in gastroenterology with that of non-specialist physicians, the Authors have carried out a retrospective study, based on the same series and on the same results, but disaggregating the global comparisons according to the feature of the clinical presentations. The latter were therefore classified by independent gastroenterologists as "typical", "atypical", or "borderline", and for each group the difference of diagnostic accuracy between program and physicians was again evaluated. Even if the program proved more accurate in all groups, the greatest difference was observed in the "borderline" group which the Authors claim to include the kind of presentation which more than any other needs a decisional aid. This should suggest a possible useful implementation of the system in daily clinical practice.

[Endobronchial administration of netilmicin in patients with bronchopulmonary infections seen in the neurosurgical intensive care unit]. / Somministrazione endobronchiale di netilmicina in pazienti con infezioni broncopolmonari ricoverati in unità di terapia intensiva neurochirurgica.

The Authors report the results obtained in the treatment of bronchopulmonary infections in patients hospitalized in the Neurosurgical Intensive Care Unit. Netilmicin was administered by systemic and endobronchial routes. The cleaning of the bronchial tree was always performed. Twenty-six patients (16 males and 10 females) were enrolled and assigned to one of the following groups. Group A: 16 patients with confirmed pneumonia; Group B: 10 patients without bronchopulmonary infections, as controls for serum pharmacokinetic study. In the majority of the cases pneumonia was caused by Staphylococcus aureus and Pseudomonas aeruginosa. The results obtained were positive: pneumonia resolution was observed in 10 patients (67%), improvement in 4 (27%) and failure in one case (6%). A pharmacokinetic study has confirmed bacteriologically active serum levels of netilmicin and also the availability of netilmicin within the bronchial secretions. Endobronchial plus systemic netilmicin administration was active and well tolerated in these critical patients.

Phenotypical and functional analysis of bronchoalveolar lavage lymphocytes in patients with HIV infection.

The lungs of patients with acquired immunodeficiency syndrome (AIDS) are frequently affected by opportunistic and nonopportunistic infections and pulmonary localizations of Kaposi's sarcoma. The aim of this study was to verify whether, in patients with human immunodeficiency virus (HIV) infections, immunologic pulmonary abnormalities set the stage for the lung complications. For this purpose, a phenotypic and functional characterization of lymphocytes recovered from the bronchoalveolar lavage (BAL) fluid of 24 patients with clinical symptoms and signs of HIV infections was performed (six patients with constitutional disease, five patients with neurologic manifestations, and 13 patients with full-blown AIDS). Our data showed that (1) in patients with HIV, the percentage and absolute number of pulmonary CD8 cells were significantly increased over those in control subjects (in 25% of these patients, mostly with full-blown AIDS, CD8 cells sustained an alveolitis); (2) lung CD4 cells were reduced in percentage but not in absolute number, with the exception of patients with AIDS in whom a significant decrease of the absolute number of BAL CD4 cells has been found (further phenotypic analysis of CD4 lymphocytes showed a reduction of the expression of T4A, B, and E with respect to the T4, T4C, T4D, and T4F epitopes); (3) although the number of BAL cells bearing NK-related determinants was increased, we were unable to demonstrate any in vitro natural killer cell activity. We suggest that the impairment of a proper NK activity in the lungs of these patients might be central to the mechanisms leading to the in situ immunodeficiency state and to the pulmonary complications characterizing AIDS.

Transbronchial lung biopsy in infiltrative lung disease. The importance of the pathologic approach.

Infiltrative diffuse lung diseases represent a heterogenous group of lesions with overlapping clinical and roentgenological features. Their diagnosis frequently needs a pathologic approach. We report our experience (671 patients with lung infiltrates) with transbronchial lung biopsy (TBB) procedure. The results of morphologic investigation were subdivided into three groups: 1) A specific morphologic diagnosis was made in 192 cases (29%) 2) Histopathologic changes well consistent with the clinical pattern were present in 258 patients (38%) 3) Non-specific lesions were found in 221 cases (33%). The diagnosis yield of the method was of 67%. UIP, DIP, Pulmonary Angiitis and Granulomatosis, Bronchiolitis Obliterans-Organizing Pneumonia and other rarer lung diseases may not be diagnosed on the basis of lesions present in TBB specimens.

Transbronchial lung biopsy and bronchoalveolar lavage in diagnosis of diffuse infiltrative lung diseases.

We investigated 801 patients with lung infiltrates who underwent transbronchial lung biopsy (TBB) and performed cytologic studies of lavage fluid of 491 patients who also underwent bronchoalveolar lavage (BAL). A specific histopathological diagnosis was made in 232 cases (29%). Histopathological changes consistent with the clinical pattern were present in 296 cases (37%). The diagnostic yield of TBB was 66%. Routine evaluation of BAL fluid allowed us to make a specific diagnosis in 49 cases. The role of the pulmonary pathologist in the interpretation of TBB and BAL specimens is discussed.