CT findings related to exposure to polyvinyl chloride.

BACKGROUND: Although some adverse health effects of exposure to polyvinyl chloride (PVC) are well known, there is limited evidence of its effects on the respiratory system. AIMS: To assess the pulmonary effects of exposure to PVC with high-resolution computed tomography (HRCT). METHODS: Workers and administrative staff of two PVC production plants completed questionnaires and went through pulmonary function testing and HRCT. Analysis of PVC dust in the work environment was performed by the Directorate of Occupational Health and Safety. RESULTS: In total, 104 PVC-exposed workers and 43 administrative controls participated. HRCT revealed pleural and/or parenchymal changes in 55% of the exposed subjects. Pleural thickening was detected in 14 subjects, 13 of whom were in the exposed group (P < 0.05). Isolated pleural thickening without parenchymal involvement was present in seven workers, who were all in the exposed group (P < 0.05). Pleural thickening was frequently bilateral and localized to the parietal and visceral pleura. Round opacities, heterogeneous attenuation and ground-glass opacities were only detected in the exposed group (P < 0.05). Exposure to dust increased the risk of findings on HRCT (odds ratio (OR) 4.2, P < 0.05). There were no correlations between pulmonary function tests or respiratory symptoms and HRCT findings. HRCT changes were more common in subjects with forced mid-expiratory flow (FEF(25-75)) < 50% (P < 0.001). CONCLUSIONS: This study found that exposure to PVC dust, at levels below the legal limit for respirable particulate matter, was associated with parenchymal changes and pleural thickening on HRCT.

Transbronchial needle aspiration in the diagnosis and staging of lung cancer.

OBJECTIVES: This study was aimed to determine effects of transbronchial needle aspiration (TBNA) in diagnosis and staging of lung cancer. METHODS: Records of 55 patients who underwent TBNA in our Chest Department from February 2002 to December 2004 were reviewed retrospectively. RESULTS: Out of 55 patients who had undergone TBNA, 30 were diagnosed to have lung cancer after complete work up. Transbronchial needle aspiration was positive for malignant cells in 12 out of 20 lung cancer patients with mediastinal lymphadenopathy on computed tomographic scan (CT scan) of the thorax. Mediastinoscopy was positive for malignancy in three cases and the remaining five had bulky lymph node enlargement which was considered malignant, given the histologic diagnosis established by other methods. Transbronchial needle aspiration was also positive for two other patients who had lymph nodes less than 1 cm size. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of TBNA in the diagnosis of lung cancer patients were 58%, 100%, 100%, 37% and 66%, respectively. CONCLUSIONS: The study demonstrates that TBNA is an efficient procedure in the diagnosis and staging of lung cancer. The diagnostic yield is increased when there is lymph node enlargement on CT scan of the thorax and reduces the need for mediastinoscopy.

Gastroesophageal reflux in the patients with asthma.

Thirty one patients with asthma (mean age was 44.4 10.7; range 18-63) were investigated for gastroesophageal reflux (GER). The patients were separated into two groups according to presence of reflux and/or nocturnal symptoms. 13 patients had one of the reflux and/or nocturnal asthma symptoms (Group 1), whereas 18 patients had none of them (Group 2). To assess GER patients underwent to scintigraphy with Tc99m. GER was determined 4 of 13 patients in group 1 (30,7 %) and 1 of 18 patients in group 2 (5,5 %). There was significant difference between the group 1 and group 2 in that respect (p < 0,001). The patients with established GER (5 patients) were given Omeprazole (a proton pomp inhibitor) 40 mg daily for 4 weeks following a 2 week placebo period. The patients recorded their daily and nocturnal symptoms of asthma, additional salbutamol use, morning and evening peak expiratory flow rates (PEFR) measurements in a daily chart during placebo and omeprazole treatment without changing their antiasthma treatment. Their PEFR, FEV1 values, daily and nocturnal symptoms and additional beta agonist use did not changed after omeprazole treatment except one. But their reflux symptoms (heartburn and regurgitation) were improved. As a consequence, we suggested that asthmatics which have some complaints of reflux should be searched for GER. Not the respiratory functions but GER symptoms can be improved w

Gastroesophageal reflux in the patiens with asthma

Thirty one patients with asthma (mean age was 44.4 ± 10.7; range 18-63) were investigated for gastroesophageal reflux (GER). The patients were separated into two groups according to presence of reflux and/or nocturnal symptoms. 13 patients had one of the reflux and/or nocturnal asthma symptoms (Group 1), whereas 18 patients had none of them (Group 2). To assess GER patients underwent to scintigraphy with Tc99m. GER was determined 4 of 13 patients in group 1 (30,7 %) and 1 of 18 patients in group 2 (5,5 %). There was significant difference between the group 1 and group 2 in that respect (p < 0,001). The patients with established GER (5 patients) were given Omepprazole (a proton pomp inhibitor) 40 mg daily for 4 weeks following a 2 week placebo period. The patients recorded their daily and nocturnal symptoms of asthma, additional salbutamol use, morning and evening peak expiratory flow rates (PEFR) measurements in a daily chart during placebo and omeoprazole treatment without changing their antiasthma treatment. Their PEFR, FEV1 values, daily and nocturnal symptoms and additional beta agonist use did not changed after omeoprazole treatment except one. But their reflux symptoms (heartburn and regurgitation) were improved. As a consequence, we suggested that asthmatics which have some complaints of reflux should be searched for GER. Not the respiratory functions but GER symptoms can be improved with antireflux treatment (AU)

En 31 pacientes (media de edad: 44,5 ñ 10,7 años) se investigó la posible existencia de reflujo gastroesofágico (RGE). Los pacientes se separaron en dos grupos, de acuerdo con la presencia de síntomas de reflujo y/o síntomas nocturnos. 13 pacientes tenían uno de los síntomas de reflujo y/o de asma nocturna (Grupo 1) mientras que los otros 18 no tenían ningún síntoma (Grupo 2). Para valorar el RGE se efectuó estudio mediante escintigrafía con 99mTc. Se encontró RGE en 4 de los 13 pacientes del grupo 1 (30,7 por ciento) y en 1 de los 18 del grupo 2 (5,5 por ciento). En este respecto, hubo diferencia significativa entre ambos grupos (p < 0,001). A los 5 pacientes con RGE establecido se les administró omeprazol (un inhibidor de la bomba de protones), 40 mg/día durante 4 semanas, seguidas de otras 2 semanas con placebo. Los pacientes anotaron los síntomas diurnos y nocturnos de asma, el consumo de salbutamol, el valor del PEF de la mañana y la noche, mientras tomaron omeprazol o placebo, sin haber cambiado el tratamiento del asma.Ninguno de estos parámetros se modificó al tomar omeprazol, salvo en uno de los pacientes. Sin embargo, mejoraron los síntomas de reflujo (acidez y regurgitación). Como consecuencia, sugerimos que a los asmáticos que tienen algunos signos de reflujo se les debería investigar un posible RGE. Con el tratamiento anti-reflujo, pueden mejorar los síntomas de RGE pero no los respiratorios (AU)

The comparison of the effects of fluticasone propionate and budesonide on clinical indices and on bone mineral density in the asthmatic patients: a one year treatment study.

BACKGROUND: it is well accepted that the inhaled administration of steroids is efficacious and has fewer side effects than the systemic use. Among them fluticasone propionate (FP) has been said to cause the similar antiasthma effect without unfavorable side effect at half the dose of the other ICS. The aim of the study was to compare the effects of FP 500 microg/day and budesonide (BUD) 800 microg/day as a pressurized metered dose inhaler (pMDI) for one year on clinical indices determined by FEV1 and diurnal variation of PEFR (peak expiratory flow rates) and on laboratory indices determined by serum cortisol and bone mineral density (BMD). METHODS: a total of 30 nonsmoking mild to moderate asthmatic patients were recruited the study. 15 patients were given 800 microg/day BUD and 15 patients were given 500 microg/day FP as a pMDI. BMD measurements were done with dual energy X-ray absorbtiometry (DEXA) before and after the treatment at the lumbar area of the spine (L1-4) and left hip (trocanter major, neck of femur, intertrocanteric region and Ward's triangle). 10 patients of BUD group and 13 of FP group completed the study. After a year of treatment period, patients were compared on the basis of clinical indices (FEV1 and variability of PEFR), on serum cortisol levels and on BMD in both groups. RESULTS: after the treatment, variability of PEFR (in BUD group p < 0,01, in FP group p < 0,001) and FEV1 (in BUD group p < 0,05, in FP group p < 0,05) were both improved in the groups. Serum cortisol levels and BMD of the patients in both groups were not changed significantly (p > 0,05). CONCLUSIONS: the results suggested that FP 500 microg/d and BUD 800 microg/d as a pMDI results in a similar antiasthma effect without causing any adverse effect on BMD in mild and moderate asthmatics after one year treatment period.

Environmental asbestos exposure and malignant pleural mesothelioma.

Asbestos-related benign and malignant pleural diseases are endemic in some rural parts of central Turkey because of environmental exposure to asbestos fibres. We report here epidemiological data on 113 patients with diffuse malignant pleural mesothelioma (DMPM) diagnosed in our clinic in Eskisehir, located in central Turkey. Of the 113 patients, 59 were men and 54 women (male:female ratio = 1). Ninety-seven patients (86%) had non-occupational asbestos exposure; all were living in villages. Their mean age was 56 years. As the patients had been exposed to asbestos from birth, the latency period was equivalent to the age of the patients. Twenty-eight patients (29%) had lived in villages their entire lives. The other 69 (71%) had been born in a village but migrated to the city or had given up white-soil usage for various reasons. The mean exposure time was 55 years for those with a long exposure period and 25 years for those with a short exposure period, but there was no significant difference between the age of the disease appearance for both groups (55 and 56 years, respectively). Thus, the latency time of mesothelioma due to environmental exposure to asbestos was longer than that due to occupational exposure, but independent of the length of exposure. Soil samples from 67 villages were analysed, comprising a population of 10,120 villagers. Tremolite and some other types of asbestos were found. In conclusion, DMPM in our region is due to mainly to environmental exposure to asbestos. The risk is substantial as a large proportion of the villagers are exposed. After smoking, asbestos exposure is one of the most serious health hazards in our rural population.

Cisplatin, mitomycin, and interferon-alpha2a combination chemoimmunotherapy in the treatment of diffuse malignant pleural mesothelioma.

STUDY OBJECTIVE: To investigate the therapeutic activity and toxicity of combination chemoimmunotherapy with cisplatin, mitomycin, and interferon (IFN)-alpha2a, by comparing the responses in a group of patients with diffuse malignant pleural mesothelioma (DMPM) to the responses in a control group of DMPM patients given supportive care alone. DESIGN: Patients with histopathologically confirmed DMPM were evaluated for treatment with chemoimmunotherapy. SETTING: After the initial evaluation, all patients received either chemoimmunotherapy or supportive care from the Osmangazi University Medical Faculty, Department of Chest Diseases. PATIENTS: Forty-three patients with DMPM received chemoimmunotherapy until the end of the survey; 19 patients were given supportive therapy alone after refusing chemoimmunotherapy. INTERVENTIONS: Drugs were administered according to the following schedule: IV cisplatin, 30 mg/m2 qd on days 1 and 2; IV mitomycin, 8 mg/m2 on day 1; and subcutaneous IFN-alpha2a, 4.5 million IU twice weekly. The courses were repeated every 4 weeks. RESULTS: Overall, 232 chemoimmunotherapy cycles were administered. A total of 10 objective responses (ORs) in 43 patients (23%) were assessed, including 2 complete responses (5%), 4 partial responses, and 4 regressions. Seventeen patients had stable disease, and 16 patients had progression. The median survival time was 11.5 months for the 43 patients who received chemoimmunotherapy and 7.0 months for the 19 patients who received supportive therapy alone. The difference in survival times between the chemoimmunotherapy and supportive therapy groups was not significant. However, the median survival time for the patients who had OR was 21.3 months, which is significantly longer than that of the patients who received supportive care alone and that of patients with progressive disease (6 months). The toxicities associated with the treatment schedule of this study were, for the most part, tolerable. CONCLUSIONS: The drug combination used in this study is moderately effective and well tolerated in patients with DMPM, especially in those who responded to the treatment.

Lymphocyte subtypes in asthma: relationship with the clinical status and bronchial hyperreactivity.

To study the role of T lymphocytes in asthma and its relationship with clinical severity, atopic status and bronchial hyperreactivity (BHR), we have examined T cell populations in peripheral blood of 32 stable asthmatic (18 non atopic, 14 atopic) and 10 non atopic-non asthmatic person using flow cytometry. BHR was determined with histamine challenge test. The percentages of CD4+, CD8+ T lymphocytes, CD4/CD8 ratios, T cell activation markers (IL-2R, CD25; HLA-DR) were not different from control (p > 0.05). The percentage of CD16+ CD56+ cells were higher in peripheral blood of asthmatics (15.5% versus 9.3% p < 0.05). In the asthmatic group, there was inverse correlation between BHR and CD4/CD8 ratio (p < 0.05). The percentages of CD5+ T lymphocytes bearing activation marker CD25 significantly higher in severely asthmatics when compared with mild asthmatics (13.2 +/- 2.0 versus 7.8 +/- 1.1% p < 0.05). These results suggest that natural killer activity is increased in the asthmatics, severely asthmatics have more T lymphocytes bearing activation marker CD25 and BHR would be related with CD4/CD8 ratio rather than the other T lymphocytes subpopulations in peripheral blood.

T lymphocyte activation in bronchoalveolar lavage of patients with interstitial lung disease.

To study the role of T-lymphocytes in the patients with alveolitis due to interstitial lung disease (ILD), we have examined T cell populations in bronchoalveolar lavage (BAL) and peripheral blood (PB) of ten patients with ILD and six normal-controls via flow cytometry. The percentages of T-lymphocytes bearing the activation markers of HLA-DR (p < 0.01) and CD25 (p < 0.05) were significantly higher in BAL of ILD patients. There was no correlation between T lymphocytes subtypes and pulmonary functions and diffusion capacity (p > 0.05). In PB of ILD patients had less CD4+ T lymphocytes and CD19 cells (B lymphocytes) than controls (p < 0.05). This increased T-lymphocyte activation in BAL in contrast to PB suggested to have a role in the pathogenesis of the lung involvement in ILD.

Misoprostol has no favorable effect on bronchial hyperresponsiveness in mild asthmatics.

Misoprostol, a synthetic prostaglandin E1 analogue, has been reported to have antibronchoconstricive and antiinflammatory effects in animal studies. We investigated the effect of misoprostol on FEV1 and bronchial hyperresponsiveness (BHR) to histamine in mildly asthmatics. 14 mildly asthmatic patients were given 400 mg/day oral misoprostol. Four patients had to left the study either due to the side effects. The remaining 10 patients (all women and mean age was 33.2 +/- 3.3) underwent the histamine challenge test before and after the treatment with misoprostol. Mean values of FEV1 obtained before and after the treatment were as follows respectively: 2.79 +/- 0.17 L; 2.78 +/- 0.18 L. Mean log PC20 values were as follows respectively: 0.60 +/- 0.23 mg/ml; 0.60 +/- 0.14 mg/ml. There was no difference either in FEV1 and log PC20 values before and after the treatment with misoprostol (p > 0.05). As a result administered misoprostol has no favorable effect on expiratory flow rates and BHR in asthmatic patients.