Lung
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Randomized Controlled Trial Comparative Study Clinical Trial
Controlled trial of inhaled fluticasone propionate in moderate to severe COPD.
Inhaled corticosteroids are often used in the treatment of stable chronic obstructive pulmonary disease (COPD), however, studies of these agents have had mixed results. Previous trials have often excluded subjects with bronchodilator response, have failed to evaluate effect on gas exchange, and have usually looked at only post- rather than prebronchodilator forced expiratory volume (FEV). Our objective was to better assess the efficacy of topical corticosteroids in the treatment of COPD. ⋯ A trend towards fewer exacerbations with fluticasone did not quite meet statistical significance (p = 0.11). Inhaled fluticasone over 3 months improved prebronchodilator airflow obstruction and oxygenation while decreasing dyspnea in moderate to severe COPD. Postbronchodilator FEV1 was not significantly changed.
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Comparative Study
Objective evidence of impairment of alveolar integrity in patients with non-insulin-dependent diabetes mellitus using radionuclide inhalation lung scan.
The alveolar integrity (AI) in 60 patients of noninsulin-dependent diabetes mellitus (NIDDM) who had normal chest X-ray findings and pulmonary function test was measured by technetium-99m (Tc-99m) diethyltriamine pentaacetic acid (DTPA) and Tc-99m hexamethylpropylen amine (HMPAO) radioaerosol inhalation lung scan (lung scan). The degree of AI damage in NIDDM was presented as the clearance rate (%/min) of hydrophilic Tc-99m DTPA and lipophilic Tc-99m HMPAO radioaerosols from the lungs. ⋯ Our findings concluded that (1) at least two different clearance mechanisms of radioaerosols in the lungs are working; and (2) the AI damage in NIDDM patients happened in both hydrophilic and lipophilic parts of the alveoli. In addition, the AI damage found by faster clearance rates of both Tc-99m DTPA and HMPAO radioaerosols may provide the other objective evidence of lung complications in NIDDM patients, which are different from the traditional studies such as chest X-ray or pulmonary function test.
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The normal structure and function of the pleura are discussed here in addition to how physiological abnormalities and various pathological processes can upset the finely balanced situation between the visceral and parietal pleural surfaces, leading to effusion formation, and/or adhesions. The various inflammatory and reactive processes that affect the pleura, together with primary and secondary tumor formations are described. Particular emphasis is placed on those conditions of the pleura that are associated with asbestos exposure because this group of diseases will increase over the next few decades due to the large number of workers who have been exposed to asbestos. They will therefore be of increasing importance to the clinician, radiologist, and pathologist in future years.
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Chronic inflammation in cystic fibrosis (CF) airways leads to high concentrations of deoxyribonucleic acid (DNA) and neutrophil elastase (NE). Both play a major role in CF lung pathophysiology and are aims of new therapeutic approaches: rhDNase degrades highly viscosic DNA and alpha1-proteinase inhibitor (alpha1-PI) inhibits NE activity and thereby pulmonary inflammation and hypersecretion. Given the reports on increased sputum NE concentrations upon rhDNase inhalation, there is a rationale for a combined rhDNase/alpha1-PI treatment. ⋯ Preincubation of alpha1-PI with rhDNase significantly reduced the inhibitory effect of alpha1-PI on purified NE activity and on NE-induced secretion. However, this effect was limited to alpha1-PI concentrations lower than those achievable after inhalation. Therefore, impairment of alpha1-PI function by rhDNase is not likely to be relevant in vivo, provided that a sufficient dosage of alpha1-PI is inhaled.
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Although gas ventilation is an integral part of partial liquid ventilation (PLV), the role of ventilation mode during PLV is not established, especially at a varying perfluorocarbon dose. In 10 surfactant-depleted rabbits, PLV was performed at a low dose (10 ml/kg) and at a functional residual capacity (FRC) dose (30 ml/kg) of perfluorodecalin in pressure-control (PC) and volume-control (VC) modes in balanced sequence. In these four PLV trials, PC mode was adjusted to be identical to VC mode with regard to tidal volume and inspiratory-to-expiratory ratio. ⋯ Actual time for inspiratory gas flow during PLV was shorter in PC mode compared with VC mode at both doses. In conclusion, in surfactant-depleted rabbit, gas exchange during PLV was better with PC mode compared with VC mode, especially at a low perfluorocarbon dose. Given the same tidal volume, PC appeared to insufflate the perfluorocarbon-filled lung better than VC at both low and FRC doses of perfluorocarbon.