ABSTRACT
We report a case of inability to ventilate a patient after completion of pneumonectomy, due to migrated tumor tissue to the contralateral side. This represents an unusual complication with a high mortality rate. We have managed to find the cause in time and were able to remove the obstructive tissue using bronchoscopy.
ABSTRACT
Polymorphonuclear leukocytes (PMNs) have been implicated in the pathogenesis of COPD, partly because of the release of oxidants, like superoxide anion (SA). The goal of this study was to measure the spontaneous and stimulated release of SA by peripheral PMN in stable COPD compared with healthy controls. Seventeen patients with stable moderate COPD and 17 healthy age-matched controls were included. SA release from peripheral PMN was measured spectrophotometrically as the superoxide dismutase (SOD) inhibitable reduction of cytochrome c. PMNs were stimulated with phorbol myristate acetate (PMA, 1 and 10 ng/ml), diesel exhaust particles (DEPs), carbon black (CB) and ultrafine CB (ufCB, 125, 250 and 500 microg/ml). The spontaneous SA release (PMA-0) between patients and control subjects was not significantly different. After stimulation with PMA, SA release increased in both patients and controls. The SA release did not increase after stimulation with DEP and CB in patients nor in controls. There was only an increase after stimulation with ufCB in the patient group. The increased SA release in COPD patients after stimulation with ufCB may suggest that PMN of COPD patients are more prone to stimulation and that the smaller particle size of ufCB might be a crucial factor.
Subject(s)
Neutrophils/metabolism , Pulmonary Disease, Chronic Obstructive/metabolism , Superoxide Dismutase/metabolism , Adult , Aged , Carbon/pharmacology , Case-Control Studies , Dose-Response Relationship, Drug , Humans , Middle Aged , Neutrophils/drug effects , Tetradecanoylphorbol Acetate/pharmacology , Vehicle EmissionsABSTRACT
The aim of the study was to determine whether zileuton, an inhibitor of 5-lipoxygenase, attenuated bronchial hyperresponsiveness (BHR) in asthmatic subjects who had marked BHR during maintenance treatment with inhaled corticosteroids (ICS). In a randomized, double-blind, placebo-controlled, cross-over study, a challenge test with histamine (provocative concentration of histamine producing a 20% fall in forced expiratory volume in one second (FEV1) (PC20,Hist)) and with ultrasonically nebulized distilled water (UNDW) (provocative dose of UNDW producing a 20% fall in FEV1 (PD20,UNDW)) was performed in seven patients with asthma after intake of either 400 mg zileuton or placebo. All patients (mean age 33 yrs, mean FEV1 111% of predicted) had marked BHR, as indicated by a mean PD20,UNDW of 4.74 mL under treatment for at least 6 months with up to 800 microg ICS (mean 536 microg daily). On four different occasions, separated by at least 5 days, two UNDW and two histamine challenge tests were performed in random order 3 h after a morning dose of either zileuton or placebo. Neither zileuton nor placebo changed baseline airway calibre prior to provocation. Zileuton increased PC20,Hist from 0.99 to 5.64 mg x mL(-1) (2.1 doubling doses; p<0.03 compared to placebo), and increased PD20,UNDW from 3.10 to 9.31 mL (1.3 doubling doses; p<0.05 compared to placebo). In conclusion, a single dose of 400 mg zileuton attenuates bronchial hyperresponsiveness to histamine and ultrasonically nebulized distilled water in asthmatic patients with marked bronchial hyperresponsiveness during treatment with inhaled corticosteroids.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Asthma/diagnosis , Asthma/drug therapy , Bronchial Hyperreactivity/drug therapy , Hydroxyurea/analogs & derivatives , Lipoxygenase Inhibitors/administration & dosage , Administration, Inhalation , Adult , Asthma/physiopathology , Bronchial Hyperreactivity/chemically induced , Bronchial Provocation Tests/methods , Cross-Over Studies , Dose-Response Relationship, Drug , Double-Blind Method , Drug Interactions , Female , Histamine , Humans , Hydroxyurea/administration & dosage , Male , Middle Aged , Reference Values , Respiratory Function Tests , Sensitivity and Specificity , WaterABSTRACT
An imbalance between oxidative stress and antioxidative capacity is thought to play an important role in the development and progression of chronic obstructive pulmonary disease (COPD). To assess the lung oxidative status in patients with COPD, we studied whether exhaled hydrogen peroxide (H2O2) is increased in breath condensate of patients with stable COPD (n = 12, mean FEV1 51% pred) and in patients with exacerbated COPD (n = 19, actual FEV1 36% pred) compared with a healthy control group (n = 10, FEV1 108% pred). Expired breath condensate during 15 min of tidal breathing was collected by cooling. The concentration of H2O2 was measured spectrophotometrically by means of horse radish peroxidase-catalyzed oxidation of tetramethylbenzidine. Concentrations of H2O2 (mean +/- SEM) were significantly elevated at 0.205 +/- 0.054 microM in patients with stable COPD compared with 0.029 +/- 0.012 microM in the control group (p < 0.05) and were further increased to 0.600 +/- 0.075 microM in patients with acutely exacerbated COPD (p < 0.001 compared with patients with stable COPD). Patients with pulmonary infiltrates on chest radiograph showed similar values compared with patients without obvious infiltrates. These findings demonstrate that patients with stable COPD exhibit increased oxidant production in the airways and that oxidant production increases further during exacerbations.
