Respiratory medicine
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Respiratory medicine · Dec 2008
Non-reversible airway obstruction in never smokers: results from the Austrian BOLD study.
The presence of non-reversible airway obstruction (AO) in never smokers has only received limited attention until now. ⋯ Approximately every third subject with non-reversible AO has never smoked, yet still demonstrates a substantial burden of symptoms and impairment of quality of life. Never smokers should receive far greater attention when efforts are undertaken to prevent and treat chronic airway obstruction.
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Extensively used current guidelines of the American Thoracic Society/European Respiratory Society (ATS/ERS) define a positive aerosolized bronchodilator (BD) response as: "...an increase in FEV(1) and/or FVC > or = 12% of control and > or = 200 mL." We hypothesized that BD responsiveness was better assessed using a statistical approach, linked to each individual's spirometric measurements, rather than the variability of others. ⋯ We believe individual t-tests may categorize patient's BD responsiveness better than ATS/ERS guideline criteria which are based on population responses and require both fixed volume and percentage changes. Its usefulness by others remains to be shown.
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Respiratory medicine · Dec 2008
Diagnostic value of interleukine-6, transforming growth factor-beta 1 and vascular endothelial growth factor in malignant pleural effusions.
We evaluate the accuracy of pleural interleukine-6 (IL-6), transforming growth factor-beta 1 (TGF-beta1), and vascular endothelial growth factor (VEGF) levels for differentiating benign from malignant pleural exudates. ⋯ Malignant effusions may enhance the release of VEGF in pleural space and its measurement may help in the diagnosis of malignant effusion.
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Respiratory medicine · Dec 2008
HRCT and histopathological evaluation of fibrosis and tissue destruction in IPF associated with pulmonary emphysema.
Idiopathic pulmonary fibrosis has been associated with emphysema in cigarette smokers as a new clinical entity: combined pulmonary fibrosis and emphysema (CPFE). In order to compare histomorphometrical, roentgenological and immunohistochemical aspects of usual interstitial pneumonia (UIP) with and without associated pulmonary emphysema, 17 patients with biopsy-proven UIP were evaluated. Morphometrical evaluation of lung parenchyma destruction was used to divide patients in two subgroups: emphysema/UIP (n=9) and UIP alone (n=8); four patients with biopsy-proven emphysema without fibrosis were also evaluated. ⋯ In contrast, fibroblasts in areas of parenchymal destruction of emphysema/UIP expressed MMP-2, MMP-9, MMP-7 and MT1-MMP at variable but significantly higher levels when compared to emphysema subjects, in the presence of similar levels of TIMP-1, TIMP-2 and TNF-alpha. Fibrotic and emphysematous lesions in emphysema/UIP patients appear to follow the roentgenological and histopathological patterns expected for either UIP or emphysema. Interstitial fibroblast activation is more pronounced in the areas of lung destruction in emphysema/UIP compared to those with emphysema alone, as for exaggerated tissue remodeling.
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We report a series of patients with postextubation pulmonary edema who had no obvious risk factors for the development of this syndrome. ⋯ It would appear that all patients, especially young men, are at risk for the development of this syndrome and that the pathogenesis remains uncertain in many cases.