Pulmonary remodeling in asthma.

For many years it was assumed that all asthmatics had an at least potentially reversible disease. It is now clear both from longitudinal studies of FEV1 and biopsy data that some asthmatics develop permanent obstructive lung disease. Some adults exhibit an accelerated decline in lung function, and some children never reach normal lung volume. The most likely histologic changes accounting for this phenomena are the deposition of collagen and glycoprotein beneath the basement membrane and in the extracellular matrix, and the destruction of elastic tissue. This permanent obstruction does not occur in all asthmatics. Factors that place patients at increased risk appear to be related to the severity and the duration of the disease and the degree of bronchial hyperresponsiveness. It is unclear, based upon present data, as to whether or not inhaled corticosteroids can favorably affect the process of remodeling, but evidence seems to favor this hypothesis. Inhaled corticosteroids, in some studies, have been shown to decrease the thickness of the lamina reticularis and retard the decline in FEV1. In addition, removal of the source of asthma, as demonstrated in occupational asthma due to toluene diisocyanate, can have a beneficial effect in this regard.

A comparison of filtered leukocyte-reduced and cytomegalovirus (CMV) seronegative blood products for the prevention of transfusion-associated CMV infection after marrow transplant.

We performed a prospective, randomized trial in CMV seronegative marrow recipients to determine if filtered blood products were as effective as CMV-seronegative blood products for the prevention of transfusion-transmitted CMV infection after marrow transplant. Before transplant, 502 patients were randomized to receive either filtered or seronegative blood products. Patients were monitored for the development of CMV infection and tissue-documented CMV disease between days 21 and 100 after transplant. Infections occurring after day 21 from transplant were considered related to the transfusion of study blood products and, thus, were considered evaluable infections for the purpose of this trial. In the primary analysis of evaluable infections, there were no significant differences between the probability of CMV infection (1.3% v 2.4%, P = 1.00) or disease (0% v 2.4%, P = 1.00) between the seronegative and filtered arms, respectively, or probability of survival (P = .6). In a secondary analysis of all infections occurring from day 0 to 100 post-transplant, although the infection rates were similar, the probability of CMV disease in the filtered arm was greater (2.4% v 0% in the seronegative arm, P = .03). However, the disease rate was still within the prestudy clinically defined acceptable rate of < or = 5%. We conclude that filtration is an effective alternative to the use of seronegative blood products for prevention of transfusion-associated CMV infection in marrow transplant patients.

Spine configuration and range of motion in normals and scoliotics.

The purposes of this study were twofold: to observe the effects of various seated postures on normal and scoliotic spines, and to investigate thoracolumbar range of motion in both normal and scoliotic spines. Eleven adolescent females with mild adolescent idiopathic scoliosis involving the thoracolumbar spine, and 20 healthy female subjects participated in the study. The Iowa Anatomical Position System was used to analyse the lumbar spine curvature. The five upright postures examined were standing, side-bending left, side-bending right, trunk extension, and trunk flexion. The seated postures consisted of erect sitting, slouched sitting, and each leg crossed two different ways in both erect and slouched positions. All seated postures were found to lie well within the extreme passive ranges of motion established by side-bending left, side-bending right, extension, and flexion. The thoracolumbar ranges of motion for scoliotics and normals were similar. Seated postures decreased the lumbar lordosis exhibited in standing for both scoliotics and normals. In general, the variety of seated postures had similar effects in normals and scoliotics, and individual seated postures varied little from each other in their effects on the thoracolumbar spine. All seated postures increased the lateral curvature in scoliotics.