Safety of formoterol Turbuhaler at cumulative dose of 90 microg in patients with acute bronchial obstruction.

This study compared the safety of formoterol (Oxis Turbuhaler; 90 microg delivered dose; 120 microg metered dose) with terbutaline (Bricanyl Turbuhaler; 10 mg), in patients with acute bronchoconstriction. Forty-eight patients (31 females) with a mean age of 45 yrs, were randomized into two parallel groups (double-blind design). Mean baseline forced expiratory volume in one second (FEV1) was 0.98 L (33% of predicted normal). Study drugs were administered on six occasions during 3 h (formoterol 4.5 microg or terbutaline 0.5 mg x inhalation(-1), 20 inhalations). Patients received intravenous prednisolone after 1.5 h and oxygen during the first 3 h. Pulse rate, serum potassium, 12-lead electrocardiogram (ECG), Holter ECG, arterial blood gases and FEV1 were assessed during 12 h after the first dose. Four patients (one formoterol, three terbutaline) discontinued. The 12-h mean values of serum potassium decreased from 4.02 to 3.89 mmol x L(-1) for formoterol and from 4.22 to 3.76 mmol x L(-1) for terbutaline. Mean 12-h pulse rate was significantly (p<0.01) higher in the terbutaline group (101.7 beats per minute (bpm)) than in the formoterol group (93.5 bpm). No individual patient value was considered clinically important or alarming. FEV1 improved in both groups but with no statistically significant difference between treatments. Oxis Turbuhaler (90 microg) was at least as safe and well tolerated as terbutaline (10 mg) [DOSAGE ERROR CORRECTED] in patients with acute bronchoconstriction.

Role of occupational asbestos exposure in Hungarian lung cancer patients.

OBJECTIVE: What is the frequency of occupational asbestos exposure among patients suffering from malignant respiratory tumours and how many of these tumours are associated with asbestos in Hungary? METHODS: An internationally established questionnaire with 29 questions, covering the most characteristic activities of asbestos exposure at the workplace was completed for 300 patients with respiratory malignancies, i.e. 297 patients with lung cancer and three with mesothelioma of the pleura. From the questionnaire, the smoking habits were estimated and cumulative asbestos exposure was assessed in fibre-years. Additionally, lung X-rays were classified and the national data on the incidence of malignant pleura mesothelioma were analysed. RESULTS: A cumulative asbestos exposure of 25 fibre-years or more was detected in 11 patients with lung cancer (4%) and in each of the three patients with pleural mesothelioma (100%). In a further 72 patients (24%), cumulative occupational asbestos exposure was assessed as below 25 fibre-years (between 0.01 and 23.9 fibre-years). In this group, car and truck mechanics, and installation and construction workers using asbestos-cement were registered. Among patients with an asbestos exposure of 25 fibre-years or more, six asbestos-cement production workers were observed, among them the three mesothelioma cases. A weak but significant association between positive X-ray findings and exposure estimates could be demonstrated. Additionally, results of the lung tissue fibre counts by scanning transmission electron microscopy were available for 25 of the lung cancer patients. A good correlation was observed between the asbestos fibre counts and the assessment of cumulative asbestos exposure. In Hungary, 84 cases of pleural mesothelioma were registered in 1997 and 73 in 1998. These numbers correspond to an annual incidence of about one new case per 100,000 inhabitants older than 15 years. CONCLUSIONS: The annual incidence of lung cancer in Hungary is about 6,000. Since in our series of lung cancer patients about 4% were observed, which could be accepted as representing occupational disease because of a cumulative exposure to 25 fibre-years or more, the annual asbestos related lung tumour incidences may be estimated to be approximately 150 or more. The proportion of nearly two estimated cases of lung cancer per case of pleural mesothelioma corresponds to international experience. Up to now, lung cancer cases only exceptionally have been registered as occupational diseases, i.e. they were seriously under-diagnosed in Hungary. For improving this situation, diagnostic assistance by a self-interview with a questionnaire covering the working history for all newly diagnosed lung cancer patients would be helpful.

Ultrasonographic urinary tract abnormalities in Schistosoma haematobium infection.

OBJECTIVE: Evaluation of ultrasonographic abnormalities with active Schistosoma haematobium infection in Yemeni patients. METHODS: As part of a cooperation between a private hospital and Schistosomiasis Control Project in Yemen, laboratory and ultrasonographic examinations were performed in 158 patients (8 females, 150 males, mean age: 17 years) with active Schistosoma haematobium infection. Upper urinary tract dilation, lower ureter changes and bladder wall abnormalities (thickness, hyperechogenicity and polypoid lesions) were registered. Laboratory findings and ultrasonographic changes were evaluated and assorted according to age groups of the patients. RESULTS: Twenty-eight patients (18%) showed no ultrasonographic morphological lesion. Bladder abnormalities (thickness, hyperechogenicity and polypoid lesions) were found in 130 patients (82%) and upper tract lesions in 86 patients (54%). No upper tract lesions were seen without bladder abnormality. Polyps within the lower ureteric lumen occurred in four patients. In patients with polypoid lesions, higher incidence of severe infection was found. One patient had urinary bladder mass. CONCLUSION: Urinary schistosomiasis has typical sonographic features, however, it may occur also without ultrasonographic morphological lesion. Upper tract lesions seem to develop only with lower tract abnormalities.

Elevated circulating adenosine level potentiates antigen-induced immediate bronchospasm and bronchoconstrictor mediator release in sensitized guinea pigs.

BACKGROUND: Adenosine causes bronchoconstriction in asthmatic patients, and it is also accepted that adenosine influences histamine release from activated human mast cells and basophils in vitro. OBJECTIVE: In this study we tested the hypothesis that adenosine potentiates both the airway narrowing and the release of bronchoconstrictor mediators induced by ovalbumin challenge in sensitized guinea pigs. METHODS: After ovalbumin sensitization, 4 groups were studied: control group, adenosine group (ADO), ovalbumin group (OA), and adenosine plus ovalbumin group (ADO + OA). Changes in airway resistance were assessed from continuously recorded pulmonary insuffilation pressure (PIP). The concentration of histamine, PGD2, and thromboxane B2 were determined from bronchoalveolar lavage fluids. RESULTS: Adenosine alone (6 mg/kg intravenously) did not influence baseline values of PIP and the mediator concentrations; however, ovalbumin (10 mg/kg intravenously) increased both the PIP and the levels of the measured mediators compared with the control and ADO groups. When ovalbumin challenge was preceded by adenosine administration, both PIP and mediator levels were significantly enhanced compared with values obtained after simple ovalbumin provocation (ADO + OA vs OA: P <.05). CONCLUSION: These results suggest that adenosine potentiates the airway narrowing induced by ovalbumin challenge and that this effect may develop through facilitation of the release of bronchoconstrictor mediators during the immediate airway response.

[Reflections on screening tests for lung cancer]. / Gondolatok a tüdörák szürövizsgálatáról.

Screening for lung cancer is a controversial issue. Much needs to be done in the area of primary prevention of lung cancer. Predictions of lung cancer mortality in Europe indicate further increases in the coming 20 years, due to the extensive number of individuals having long periods of exposure to carcinogens. The treatment of lung cancer is not solved, either, and the global epidemiological situation of lung cancer raises great concerns. Due to these reasons, it seems to be necessary to revise the issue of lung cancer screening. In Hungary, annual minimal mass roentgen screening has been done for decades. The data of more than 4.3 million individuals were analysed in 1996. Out of the symptomless patients detected, 21.4% fell into oncological stage 1, 33.7% into stage 2 and 29% into stage 3. Those patients who were not screened, but who presented with symptoms and were detected as such, can be classified into stages as follows: Stage 1: 8.7%, stage 2: 21.5% and stage 3: 36.3%. The resection rate in the screened group versus non-screened group was 34.3% and 13.7% respectively. Minimal mass roentgen screening allows the detection of lung cancer patients in an earlier stage; with improved treatment possibilities, survival rates and patients' quality of life will shift to a positive direction. It is suggested that the effectiveness of minimal mass roentgen screening of lung cancer should be revised.

[Ureteral obstruction caused by retroperitoneal metastasis of gastric carcinoma]. / Obstruction urétérale par métastases rétropéritonéales du carcinome gastrique.

Nine patients with ureteric obstruction caused by retroperitoneal metastasis of gastric tumor have been observed in our clinic during the last five years. In all cases flank pain and the dilatation of the renal collecting system were the first signs of the disease. Despite the urological and radiological examinations in 3 cases the exact cause of the occlusion could be established only by autopsy. Most of the carcinomas showed the same histological type and were advanced tumors at the time of diagnosis. This kind of aggressive tumor carries a very poor prognosis, palliative nephrostomy has been performed.

Early and late complications of uretero-enteric anastomosis.

The authors report on early and late complications of uretero-enteric anastomosis. The results of pre- and postoperative US evaluations in 67 patients with urinary diversion using isolated bowel segment are reviewed. Ultrasonography (US) is the first method of choice in recognizing postoperative complications. Authors observed 5 early and 5 late complications directly related to the uretero-enteric anastomosis operation. Possible treatment modalities and the role of US guided nephrostomy are discussed.

[Immunomodulation therapy in chronic bronchitis (multicenter study)]. / Immunmodulációs terápia idült hörghurutban (multicentrikus vizsgálat).

(A multicentre clinical trial) The authors treated 120 patients showing the symptoms of chronic bronchitis with BV or placebo for 6 months during the winter period of 1992-93 in a multicentre double-blind clinical trial. The status of the patients was evaluated monthly and the data were analyzed at an independent computer company. The clinical symptoms were significantly milder in the BV group as compared with the placebo group and antibiotics consumption in the BV group was almost half of that recorded in the placebo group. These findings confirm that BV can be effective in the prophylaxis of the exacerbation of chronic bronchitis.

[Treatment of iatrogenic obstructions of the ureter following hysterectomy]. / Traitement des obstructions iatrogènes de l'uretère, après hystérectomie.

Ureteral injury after abdominal hysterectomy has been observed in 14 patients between 1988 and 1992. Open surgery, percutaneous nephrostomy, double pigtail stent insertion using antegrade and retrograde route, and balloon dilatation were used for treatment. The experience of the authors is reviewed.

Effects of ketotifen and clenbuterol on beta-adrenergic receptor functions of lymphocytes and on plasma TXB-2 levels of asthmatic patients.

Clinical observations indicate that beta-adrenergic drugs may increase bronchial reactivity in asthmatics. To find out possible reasons for this phenomenon the beta-adrenergic receptor function of isolated lymphocytes of asthmatic patients treated with clenbuterol alone or with ketotifen and clenbuterol together were studied. The cAMP levels of lymphocytes stimulated by different doses of isoproterenol were measured by radioimmunoassay and have been compared in the groups of healthies, and asthmatic patients after 3-months running of clenbuterol (Spiropent, Sandoz), as well as in the same asthmatics after one-week running of parallel administration of ketotifen and clenbuterol. There was no difference between the beta-adrenergic receptor function in asthmatic patients treated with clenbuterol alone vs. untreated healthies. Applying ketotifen and clenbuterol together the beta-adrenergic receptor function increased compared to the values obtained after application of clenbuterol alone (intraindividual-control) as well as vs. the group of healthies (control). Data presented support the view that therapeutic doses of selective beta 2-agonists do not lead to damage of the beta-adrenoceptor function. The improvement of receptor function after parallel administration of clenbuterol and ketotifen may be a consequence of the participation of ketotifen in the control of beta-adrenergic receptor system. Thus it seems unlikely that down-regulation of beta-adrenergic receptors is responsible for the beta-agonist induced bronchial hyperreactivity. That's why TXB-2 levels in the plasma of the same asthmatic patients and healthy volunteers were determined by RIA.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bladder repair using an ileocecal segment]. / Hólyagpótlás kirekesztett coecum-ileumból.

Subtotal cystectomy and bladder replacement from shorted-out ileocecal segment as well as uretero-ileostomy was carried out in a 25-year-old woman because of a contracted urinary bladder, consequence of a developmental disorder, i.e. colonic-type mucous membrane of the bladder. The patient is continent passes urine every 3-4 hours without residuum.

Development of drug tachyphylaxis in asthmatic patients treated with beta-adrenergic drugs.

The development of drug tolerance in two groups of asthmatics treated with beta-adrenergic bronchodilators was studied by respiratory function methods. During one-year treatment with conventional therapeutic doses of selective beta-2-receptor stimulant aerosols, none of the patients showed subsensitivity to the bronchodilatory effect of terbutaline. Dose-response curves were plotted upon the inhalation of salbutamol in two-week intervals in patients treated with betamimetics. There was no decrease in the airways beta-adrenergic receptor function as compared to the untreated control group. The results show that prolonged treatment with therapeutic doses of inhaled beta-adrenergic bronchodilators does not result in drug tachyphylaxis, which is in accord with the clinical experience that there is no loss of effect of the preparations during their continuous administration.

Serum angiotensin converting enzyme values in chronic obstructive pulmonary disease.

Angiotensin converting enzyme (ACE) is stored in the endothelium. Its activity depends--among others--on the O2-concentration of the blood. Aim of the study was to examine the serum ACE values in chronic obstructive lung diseases (bronchial asthma, chronic bronchitis, lung fibrosis etc.). At the time of blood sampling, blood-gas tensions and respiratory function parameters of the patients were also determined. On the basis of the blood-gas parameters and SACE x + SD and x--SD values, obtained from the normoxic-normocapnic group, the patients could be divided into sub-groups. In contrast to data in the literature increased enzyme levels in response to hypoxia could be found only in patients suffering from a pulmonary disease associated with severe tissue damage.