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See detailAdherence to Continuous Positive Airway Pressure (CPAP) Therapy
Deflandre, Eric ULg; Degey, Stéphanie; BONHOMME, Vincent ULg et al

in CHEST (2014, March), 145

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See detailExertional hypoxemia in stable COPD is common and predicted by circulating proadrenomedullin.
Stolz, Daiana; Boersma, Wim; Blasi, Francesco et al

in Chest (2014)

BACKGROUND: The prevalence of exertional hypoxemia in unselected COPD patients is unknown. Intermittent hypoxia leads to adrenomedullin (ADM) up regulation through the HIF-1 pathway. We aimed to assess ... [more ▼]

BACKGROUND: The prevalence of exertional hypoxemia in unselected COPD patients is unknown. Intermittent hypoxia leads to adrenomedullin (ADM) up regulation through the HIF-1 pathway. We aimed to assess the prevalence and the annual probability to develop exertional hypoxemia in stable COPD. We also hypothesized that increased ADM might be associated with exertional hypoxemia and envisioned that adding ADM to clinical variables might improve its prediction in COPD. METHODS: 1233 6-minute walking tests and circulating proadrenomedullin levels from 574 patients with clinically stable, moderate to very severe COPD enrolled in a multinational cohort study and followed-up for 2 years were concomitantly analyzed. RESULTS: The prevalence of exertional hypoxemia was 29.1%. In a matrix derived from a fitted-multi-state model, the annual probability to develop exertional hypoxemia was 21.6%. Exertional hypoxemia was associated with greater deterioration of specific domains of health-related QoL, higher severe exacerbation and death annual rates. In the logistic linear and conditional Cox-regression multivariable analyses, both FEV1% predicted and proADM proved independent predictors of exertional hypoxemia (p<0.001 for both). Adjustment for comorbidities, including cardiovascular disorders, and exacerbation-rate did not influence results. Relative to using FEV1% pred alone, adding proADM resulted in a significant improvement of the predictive properties (p=0.018). Based on the suggested non-linear nomogram, patients with moderate COPD (FEV1 predicted=50%) but high proADM levels (>2nmol/l) presented increased risk (>30%) for exertional desaturation. CONCLUSIONS: Exertional desaturation is common and associated with poorer clinical outcomes in COPD. Adrenomedullin improves prediction of exertional desaturation as compared to the use of FEV1%pred alone. [less ▲]

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See detailGenetic Analysis of Rwandan Patients With Cystic Fibrosis-Like Symptoms: Identification of Novel Cystic Fibrosis Transmembrane Conductance Regulator and Epithelial Sodium Channel Gene Variants.
Mutesa, Léon; Azad, Abul Kalam; Verhaeghe, Catherine ULg et al

in CHEST (2009), 135(5), 1233-42

Background The defect in chloride and sodium transport in cystic fibrosis (CF) patients is a consequence of CFTR loss of function and of an abnormal interaction between CFTR and ENaC. A few patients were ... [more ▼]

Background The defect in chloride and sodium transport in cystic fibrosis (CF) patients is a consequence of CFTR loss of function and of an abnormal interaction between CFTR and ENaC. A few patients were described with CF-like symptoms, a single CFTR mutation and an ENaC mutation. Methods To study African patients with CF-like symptoms and to relate the disease to gene mutations of both CFTR and ENaC genes, we collected clinical data and DNA samples from 60 African patients with a CF phenotype. The CFTR gene was first analyzed in all patients by dHPLC followed by direct sequencing, whereas the SCNN1A, SCNN1B and SCNN1G subunits of ENaC gene were analyzed by sequencing in the five patients who carried only one CF mutation. The frequency of all identified ENaC variants was established in a control group of 200 healthy individuals and in the 55 CF-like patients without any CFTR mutation Results Three CFTR mutants, including one previously undescribed missense mutation (p.A204T), and a 5T/7T variant were identified in five patients. ENaC gene sequencing in these 5 patients detected 8 ENaC variants: c.72T>C and p.V573I in SCNN1A; p.V348M, p.G442V, c.1473 + 28C>T, and p.T577T in SCNN1B; and p.S212S, c.1176 + 30G>C in SCNN1G. In the 55 CF-like patients without any CFTR mutation, we identified five of these eight ENaC variants, including the frequent p.G442V polymorphism, but we did not detect the presence of the p.V348M, p.T577T, and c.1176 + 30G>C ENaC variants. Moreover, these last three ENaC variants, p.V348M, p.T577T, and c.1176 + 30G>C, were not found in the control group. Conclusion Our data suggest that CF-like syndrome in Africa could be associated with CFTR and ENaC mutations. [less ▲]

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See detailLeukotriene B4 Contributes to Exhaled Breath Condensate and Sputum Neutrophil Chemotaxis in COPD.
Corhay, Jean-Louis ULg; Henket, Monique ULg; Nguyen Dang, Delphine ULg et al

in CHEST (2009), 136(4), 1047-1054

Background Neutrophils have been implicated in the pathogenesis of COPD. Several chemoattractants for neutrophils have been measured in exhaled breath condensate (EBC) and induced-sputum (IS) from ... [more ▼]

Background Neutrophils have been implicated in the pathogenesis of COPD. Several chemoattractants for neutrophils have been measured in exhaled breath condensate (EBC) and induced-sputum (IS) from patients with COPD. Objectives The aims of this study were to compare EBC and IS supernatant neutrophil chemotactic activity from ex-smoking COPD and healthy ex-smokers, and to assess the contribution of LTB(4) to this activity. Methods 34 COPD were compared to 24 controls. EBC and IS chemotactic activity for neutrophils were assessed by using Boyden microchambers. Chemotactic index (CI) was used to evaluate cell migration. LTB(4) was measured by a specific enzyme immunoassay. Contribution of LTB4 to EBC and sputum neutrophil chemotaxis was assessed by an LTB(4) receptor antagonist (U-75302: Cayman Chemical Company, Ann Arbor, MI, USA). Results EBC and IS from both COPD and healthy subjects displayed significant neutrophil chemotactic activity but this activity was raised in COPD compared to healthy subjects. Chemotactic activity contained in sputum, however, failed to correlate with that in EBC. In COPD there was a significant correlation between EBC neutrophil chemotactic activity and sputum neutrophil counts. LTB(4) levels were raised in EBC, but not in sputum, from COPD as compared to healthy subjects. LTB(4) receptor antagonist (2.5 10(-4) M) reduced by 44.6% and by 44.4% chemotactic activity contained in EBC and sputum respectively. Conclusions EBC and IS from COPD patients have a raised neutrophil chemotactic activity to which LTB4 contributes. [less ▲]

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See detailGoal-directed Intraoperative therapy reduces morbidity and length of hospital stay in high-risk surgical patients
Donati, A.; Loggi, S.; Preiser, Jean-Charles ULg et al

in Chest (2007), 132(6), 1817-1824

Background: Postoperative organ failures commonly occur after major abdominal surgery, increasing the utilization of resources and costs of care. Tissue hypoxia is a key trigger of organ dysfunction. A ... [more ▼]

Background: Postoperative organ failures commonly occur after major abdominal surgery, increasing the utilization of resources and costs of care. Tissue hypoxia is a key trigger of organ dysfunction. A therapeutic strategy designed to detect and reverse tissue hypoxia, as diagnosed by an increase of oxygen extraction (0,ER) over a predefined threshold, could decrease the incidence of organ failures. The primary aim of this study was to compare the number of patients with postoperative organ failure and length of hospital stay between those randomized to conventional vs a protocolized strategy designed to maintain O2ER < 27%. Methods: A prospective, randomized, controlled trial was performed in nine hospitals in Italy. One hundred thirty-five high-risk patients scheduled for major abdominal surgery were randomized in two groups. All patients were managed to achieve standard goals: mean arterial pressure > 80 mm Hg and urinary output > 0.5 mL/kg/h. The patients of the "protocol group" (group A) were also managed to keep O2ER < 27%. Measurements and main results: In group A, fewer patients had at least one organ failure (n = 8, 11.8%) than in group B (n = 20, 29.8%) [p < 0.05], and the total number of organ failures was lower in group A than in group B (27 failures vs 9 failures, p < 0.001). Length of hospital stay was significantly lower in the protocol group than in the control group (11.3 +/- 3.8 days vs 13.4 +/- 6.1 days, p < 0.05). Hospital mortality was similar in both groups. Conclusions: Early treatment directed to maintain O2ER at < 27% reduces organ failures and hospital stay of high-risk surgical patients. Clinical trials.gov reference No. NCT00254150. [less ▲]

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See detailGranulocyte chemotactic activity in exhaled breath condensate of healthy subjects and patients with COPD
Corhay, Jean-Louis ULg; Hemelaers; Henket, Monique ULg et al

in CHEST (2007), 131(6), 1672-1677

Background. Several chemoattractants have been measured in exhaled breath condensate (EBC) from patients with COPD. The aim of this study was to compare the eosinophil. and neutrophil chemotactic activity ... [more ▼]

Background. Several chemoattractants have been measured in exhaled breath condensate (EBC) from patients with COPD. The aim of this study was to compare the eosinophil. and neutrophil chemotactic activity contained in EBC from healthy subjects and patients with COPD. Methods: EBC collected using a commercially available condenser (EcoScreen; Erich Jaeger Viasys; Hoechberg, Germany) was compared in 45 COPD patients and 65 healthy subjects. EBC chemotactic activity for eosinophils and neutrophils was assessed using microchambers (Boyden; Neuro Probe; Cabin John, MD). Chemotactic index (CI) was used to evaluate cell migration. Results: EBC from patients with COPD (C1, 2.21 +/- 0.16 [mean +/- SEM]) and healthy subjects (CI, 1.67 +/- 0.11) displayed significant neutrophil chemotactic activity (p < 0.0001 for both), which was however higher in patients with COPD (p < 0.001). Healthy smokers had a significantly raised C1 for neutrophils by comparison with healthy nonsmokers (p < 0.01) and ex-smokers (p < 0.05). Ukewise, current COPD smokers tended to have greater neutrophil C1 than COPD who stopped smoking (p = 0.08). COPD ex-smokers had raised chemotactic activity by comparison with healthy ex-smokers (p < 0.05). Anti-interleuldn-8 (10(-6) g/mL) antibodies reduced neutrophil chemotactic activity by 35.2% (p < 0.05). EBC also contained significant eosinophil chemotactic activity in healthy subjects (CI, 1.68 0.09; p < 0.0001) and patients with COPD (CI, 1.23 +/- 0.07; p < 0.01), with a significantly lower CI in patients with COPD as compared to healthy subjects (p < 0.001). Smoking did not influence eosinophil chemotactic activity in healthy subjects or patients with COPD. Conclusions: Current smoking favors neutrophil chemotactic activity. As compared to healthy subjects, EBC from patients with COPD displays a skewed chemotactic activity toward neutrophils vs eosinophils. [less ▲]

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See detailEvaluation of pleural disease with 18-fluorodeoxyglucose positron emission tomography imaging
Duysinx, Bernard ULg; Nguyen, Delphine; Louis, Renaud ULg et al

in CHEST (2004), 125(2), 489-493

STUDY OBJECTIVES: To study the ability of positron emission tomography (PET) using 18-fluorodeoxyglucose (FDG) to distinguish between benign and malignant disease in exudative pleural effusions and ... [more ▼]

STUDY OBJECTIVES: To study the ability of positron emission tomography (PET) using 18-fluorodeoxyglucose (FDG) to distinguish between benign and malignant disease in exudative pleural effusions and pleural thickening. DESIGN: Prospective study of 98 consecutive patients presenting with either pleural thickening or an exudative pleural effusion. SETTING: Department of pulmonary medicine of a university hospital. METHODS: FDG-PET was performed on each subject before invasive procedures were used to determine the etiologic diagnosis. FDG-PET data were analyzed by visual interpretation. RESULTS: Sixty-three of 98 patients were found to have malignant pleural disease after histologic analysis. Sixty-one of 63 patients with histologically confirmed malignant disease showed FDG uptake within the area of pleural thickening. Uptake was graded as intense in 51 cases and moderate in 10 cases. Only two patients with malignant pleural disease did not show increased FDG uptake. FDG-PET imaging showed an absence of FDG uptake, and correctly classified 31 of 35 benign lesions. For the remaining four lesions, intense FDG uptake was seen in one case of parapneumonic effusion, while moderate and localized uptake was observed in one parapneumonic, one tuberculous, and one uremic pleurisy. The sensitivity of the method to identify malignancy was 96.8% with a negative predictive value of 93.9%, while its specificity was 88.5% and its positive predictive value was 93.8%. CONCLUSIONS: Our results suggest that FDG-PET is an effective tool for differentiating between benign and malignant pleural diseases. [less ▲]

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See detailMatrix metalloproteinase-9, but not tissue inhibitor of matrix metalloproteinase-1, increases in the sputum from allergic asthmatic patients after allergen challenge
Cataldo, Didier ULg; Bettiol, J.; Noël, Agnès ULg et al

in CHEST (2002), 122(5), 1553-1559

Objective: The aim of the study was to determine whether allergen inhalation modulates the levels of matrix metalloproteinase (MMP)-9 and tissue inhibitor of matrix metallloproteinase (TIMP)-1 in the ... [more ▼]

Objective: The aim of the study was to determine whether allergen inhalation modulates the levels of matrix metalloproteinase (MMP)-9 and tissue inhibitor of matrix metallloproteinase (TIMP)-1 in the induced sputum recovered from patients during a late-phase reaction. Method: Eight allergic asthma patients and five healthy control subjects inhaled a dose of Dermatophagoides pteronyssinus extract corresponding to the provocative concentration of the allergen causing a 20% fall in FEV1 and saline solution. Lung function was carefully monitored for 6 h, and an induced sputum test was performed at 6 h after sham challenge or allergen challenge. The total and differential cell counts were analyzed, and the levels of MMP-9 (by enzyme-linked immunosorbent assay [ELISA] and zymography), TIMP-1 (by ELISA), and albumin (by rocket immunoelectrophoresis) were measured. Results: The sputum eosinophil counts (p < 0.01) and MMP-9 levels (p < 0.05) increased significantly in atopic asthma patients after undergoing the allergen challenge but did not in the control subjects. By contrast, TIMP-1 and albumin levels were not significantly increased in any group. MMP-9 levels, measured after the allergen challenge in asthmatic patients, were significantly correlated with FEV1 variations after allergen inhalation (r = 0.51; p < 0.05) and with the sputum neutrophil percentage (r = 0.71; p < 0.01). Conclusion: The levels of MMP-9, but not TIMP-1, increase after inhaled allergen challenge in the sputum of allergic asthmatic patients. This protease increase may lead to a transient imbalance between MMP-9 and TIMP-1 favoring proteolytic extracellular matrix degradation. [less ▲]

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See detailInduced sputum - Comparison between isotonic and hypertonic saline solution inhalation in patients with asthma
Cataldo, Didier ULg; Foidart, Jean-Michel ULg; Lau, L. et al

in CHEST (2001), 120(6), 1815-1821

Background: Sputum induction by hypertonic saline solution inhalation is widely used to study airways secretions in patients with asthma. However, hypertonic saline solution is a potent indirect ... [more ▼]

Background: Sputum induction by hypertonic saline solution inhalation is widely used to study airways secretions in patients with asthma. However, hypertonic saline solution is a potent indirect bronchoconstrictor. Study objectives: We studied the validity of isotonic saline solution (0.9%) inhalation as a means to induce sputum by comparing it to hypertonic saline solution (4.5%) inhalation. Patients: Sixteen patients with moderate-to-severe asthma reporting a clinical history of mucus hypersecretion. Methods: Subjects underwent sputum induction twice at 1-week intervals. Saline solution (hypertonic or isotonic) was inhaled For three periods of 5 min. The parameters assessed in sputum samples were cell counts, sodium, eosinophil cationic protein (ECP), and albumin concentrations, osmolality, and pro-matrix metalloproteinase (MMP)-9 activity by zymography. Results: The maximal fall in peak expiratory flow during sputum induction was greater after inhalation of hypertonic saline solution than after inhalation of isotonic saline solution (p < 0.01). Each subject produced analyzable sputum on both visits. There were no statistically significant differences in total and differential sputum cell counts, and the reproducibility coefficients were high for eosinophils and neutrophils when comparing the two methods. Likewise, sputum levels of ECP and albumin as well as sputum pro-MMP-9 activity were not different between the two methods, and were highly reproducible as shown by high intraclass coefficients (Ri) of correlation (0.72, 0.74, and 0.77 for ECP, albumin, and pro-MMP-9, respectively). Sputum sodium concentrations and osmolality were higher after inhalation of hypertonic saline solution (p < 0.05). Conclusion: In patients with moderate-to-severe asthma reporting a clinical history of mucus hypersecretion, inducing sputum by isotonic or hypertonic saline solution inhalation leads to comparable results in eosinophil and neutrophil cell counts and fluid phase mediators/proteins. [less ▲]

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See detailPathophysiology of a fall in arterial oxygen saturation during sputum induction.
Cataldo, Didier ULg

in CHEST (2000), 117(6), 1818-9

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See detailSuccessful Treatment of Pulmonary Lymphangioleiomyomatosis with Progestins: A Case Report
Denoo, Xavier ULg; Hermans, Gilberte ULg; Degives, R. et al

in CHEST (1999), 115(1), 276-9

The diagnostic approach, clinical evolution, and treatment of a patient with primary pulmonary lymphangioleiomyomatosis are reported. This patient presented a restrictive respiratory syndrome resistant to ... [more ▼]

The diagnostic approach, clinical evolution, and treatment of a patient with primary pulmonary lymphangioleiomyomatosis are reported. This patient presented a restrictive respiratory syndrome resistant to conventional glucocorticoid therapy. The diagnosis, based on clinical and histologic examinations, was confirmed by immunohistochemical localization of one of the desmins, the smooth muscle cell actin, and HMB45 antigen. The patient received treatment with an anti-estrogenic agent (tamoxifen citrate) and high doses of medroxyprogesterone acetate, an antigonadotropic progestin. Respiratory function improved rapidly with clinical relief. [less ▲]

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See detailEffect of bi-level positive airway pressure (BiPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty.
Joris, Jean ULg; Sottiaux, Thierry; Chiche, Jean-Daniel et al

in CHEST (1997), 111(3), 665-70

STUDY OBJECTIVE: Upper abdominal surgery results in a postoperative restrictive pulmonary syndrome. Bi-level positive airway pressure (BiPAP System; Respironics Inc; Murrysville, Pa), which combines ... [more ▼]

STUDY OBJECTIVE: Upper abdominal surgery results in a postoperative restrictive pulmonary syndrome. Bi-level positive airway pressure (BiPAP System; Respironics Inc; Murrysville, Pa), which combines pressure support ventilation and positive end-expiratory pressure via a nasal mask, could allow alveolar recruitment during inspiration and prevent expiratory alveolar collapse, and therefore limit the postoperative pulmonary restrictive syndrome. This study investigated the effect of BiPAP on postoperative pulmonary function in obese patients after gastroplasty. DESIGN: Prospective controlled randomized study. SETTING: GI surgical ward in a university hospital. PATIENTS: Thirty-three morbidly obese patients scheduled for gastroplasty were studied. INTERVENTION: The patients were assigned to one of three techniques of ventilatory support during the first 24 h postoperatively: O2 via a face mask, BiPAP System 8/4, with inspiratory and expiratory positive airway pressure set at 8 and 4 cm H2O, respectively, or BiPAP System 12/4 set at 12 and 4 cm H2O. Pulmonary function (FVC, FEV1, and peak expiratory flow rate [PEFR]) were measured the day before surgery, 24 h after surgery, and on days 2 and 3. Oxygen saturation by pulse oximeter (SpO2) was also recorded during room air breathing. RESULTS: Three patients were excluded. After surgery, FVC, FEV1, PEFR, and SpO2 significantly decreased in the three groups. On day 1, FVC and FEV1 were significantly improved in the group BiPAP System 12/4, as compared with no BiPAP; SpO2 was also significantly improved. After removal of BiPAP System 12/4, these benefits were maintained, allowing faster recovery of pulmonary function. No significant effects were observed on PEFR. BiPAP System 8/4 had no significant effect on the postoperative pulmonary restrictive syndrome. CONCLUSION: Prophylactic use of BiPAP System 12/4 during the first 24 h postoperatively significantly reduces pulmonary dysfunction after gastroplasty in obese patients and accelerates reestablishment of preoperative pulmonary function. [less ▲]

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See detailAcute Bronchial and Hematologic Effects Following Inhalation of a Single Dose of Paf. Comparison between Asthmatics and Normal Subjects
Louis, Renaud ULg; Bury, Thierry ULg; Corhay, Jean-Louis ULg et al

in CHEST (1994), 106(4), 1094-9

This study compared the acute bronchial and hematologic effects of inhaled platelet activating factor (PAF) (30 micrograms as a single dose) in 19 patients with mild asthma and 19 normal subjects. Each ... [more ▼]

This study compared the acute bronchial and hematologic effects of inhaled platelet activating factor (PAF) (30 micrograms as a single dose) in 19 patients with mild asthma and 19 normal subjects. Each subject underwent a methacholine bronchial challenge 1 week before PAF challenge to determine the concentration of methacholine causing a 20 percent fall in FEV1 (PC20M). On the day of PAF challenge, specific conductance (SGaw), FEV1, FEF25-75, and platelet and leukocyte counts were measured before, and 5, 10, 15, and 20 min after PAF inhalation. Changes in pulmonary and hematologic parameters were expressed as percent of control (saline solution/ethanol solution). Unlike normal subjects, subjects with asthma had bronchial hyperresponsiveness to methacholine: geometric mean (range): 0.59 mg/ml (0.07 to 9.8) vs > 32 mg/ml. Acute bronchial obstruction over the first 20 min after PAF inhalation was more pronounced in asthmatics than in normal subjects whatever the functional index considered (p < 0.01). In asthmatics (n = 19), mean (SEM) maximal fall in SGaw, FEV1, and FEF25-75 reached 50 percent (6), 11 percent (4), and 19 percent (5), respectively, while in normal subjects (n = 19) the maximal decreases were 24 percent (6), 4 percent (1), and 6 percent (1), respectively. In asthmatics, no correlation was found between log PC20M and log fall in FEV1 after PAF (r = 0.04 p > 0.05). In asthmatics and normal subjects, inhaled PAF caused a transient fall in neutrophils and monocytes by 5 min followed by a full recovery at 15 min and 20 min. These hematologic changes were not significantly different between the two groups. While not correlated with their airway responsiveness to methacholine, asthmatics, compared with normal subjects, develop an exaggerated acute airway obstruction in response to PAF. In contrast, hematologic changes induced by PAF do not differ between asthmatics and normal subjects. [less ▲]

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See detailNo Increase in Plasma Histamine During Paf-Induced Airway Obstruction in Allergic Asthmatics
Louis, Renaud ULg; Bury, Thierry ULg; Corhay, Jean-Louis ULg et al

in CHEST (1993), 104(3), 806-10

To investigate the possible role of mast cell or basophil histamine release in mediating platelet-activating factor (PAF) airway obstruction, we studied the effect of inhaled PAF (30 micrograms, single ... [more ▼]

To investigate the possible role of mast cell or basophil histamine release in mediating platelet-activating factor (PAF) airway obstruction, we studied the effect of inhaled PAF (30 micrograms, single dose) on plasma histamine, bronchial caliber, and leukocyte and platelet counts in six patients with mild or moderate allergic asthma (mean age, 27 +/- 1.3 years; mean FEV1, 95 +/- 5 percent of predicted; mean PC20 methacholine, 1.46 +/- 0.36 mg/ml). Specific conductance (SGaw) FEV1, FEF25-75 percent, differential leukocyte and platelet counts, and plasma histamine (radioimmunoassay) were measured before and 5, 10, 15, and 20 min after PAF inhalation. Mean basal plasma histamine level was 0.28 +/- 0.04 ng/ml. Inhalation of PAF caused a fall in SGaw peaking at 5 min (43 +/- 9 percent) and a fall in FEV1 and FEF25-75 peaking at 10 min (19 +/- 10 percent and 30 +/- 13 percent, respectively). There was also a rapid and transient fall in circulating neutrophils at 5 min (from 3,096 +/- 204/mm3 to 2,551 +/- 158/mm3, p < 0.05) followed by a rebound neutrophilia. In contrast, plasma histamine level did not change significantly at any time measured. Conversely in the same asthmatics, a rapid rise in plasma histamine level (from 0.29 +/- 0.03 ng/ml at baseline to 0.53 +/- 0.06 ng/ml at 5 min; p < 0.01) was observed after an allergenic challenge (Dermatophagoides pteronyssinus) causing a fall in FEV1 peaking at 10 min (22 +/- 4 percent). Thus, inhaled PAF may induce airway obstruction and neutropenia in asthmatics without any significant change of plasma histamine level. These results indicate that it is unlikely that lung mast cells or basophils degranulate during PAF-induced bronchoconstriction. [less ▲]

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See detailComparative evaluation of three heat and moisture exchangers during short-term postoperative mechanical ventilation
Sottiaux, Thierry; Mignolet, Ghislaine ULg; Damas, Pierre ULg et al

in CHEST (1993), 104(1), 220-224

This study compared performance of three heat and moisture exchangers (HME) during short-term postoperative mechanical ventilation. Temperature and absolute humidity (AH) were measured at various points ... [more ▼]

This study compared performance of three heat and moisture exchangers (HME) during short-term postoperative mechanical ventilation. Temperature and absolute humidity (AH) were measured at various points of the ventilatory circuit. There was no statistical difference between the groups, regarding ambient and body To, body weight, fraction of inspired oxygen, tidal volume, and respiratory rate. Only the hygroscopic HME (groups 2 and 3) provide adequate conditioning with regard to AH and To of the inspiratory gases. The performance of hydrophobic HME (group 1) was inferior and appears to be unsatisfactory. Indirect evaluation (variations of inspiratory gases and tracheal temperatures, AH of the expired gases) confirmed the superiority of the hygroscopic HME. These data suggest that humidification of inspiratory gases with a hygroscopic HME is a defensible practice during short-term postoperative mechanical ventilation. Performance of hydrophobic HME may be weak and can expose the patient to an unacceptable risk of endotracheal tube occlusion. [less ▲]

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See detailFailure of Buserelin-Induced Medical Castration to Control Pulmonary Lymphangiomyomatosis in Two Patients
RADERMECKER, Marc ULg; Broux, R.; Corhay, Jean-Louis ULg et al

in CHEST (1992), 101(6), 1724-6

Two women, aged 44 and 29 years, respectively, were admitted to the hospital in early 1987 for recurrent pneumothorax, dyspnea and a diffuse reticulonodular pattern evidenced on the chest x-ray film. Lung ... [more ▼]

Two women, aged 44 and 29 years, respectively, were admitted to the hospital in early 1987 for recurrent pneumothorax, dyspnea and a diffuse reticulonodular pattern evidenced on the chest x-ray film. Lung biopsy confirmed LAM in both patients. Both were treated sequentially with medroxyprogesterone and a LHRH agonist (buserelin) to achieve reversible medical castration. Neither subjective nor objective improvement was noted after 13 and 5 months, respectively, of buserelin therapy (900 micrograms/day, nasal spray) despite an effective suppression of the pituitary-gonadal axis. Medroxyprogesterone also was ineffective. Buserelin thus failed to control pulmonary LAM in these two patients, in spite of effective medical castration. [less ▲]

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See detailLeft Main Coronary Dissection after Mild Chest Trauma. Favorable Evolution with Fibrinolytic and Surgical Therapies
Boland, Jean; Limet, Raymond ULg; Trotteur, Geneviève ULg et al

in CHEST (1988), 93(1), 213-4

A 32-year-old woman had acute anterior myocardial infarction after a mild chest trauma (automobile accident). Unstable angina recurred shortly after admission, and extensive dissection of the left ... [more ▼]

A 32-year-old woman had acute anterior myocardial infarction after a mild chest trauma (automobile accident). Unstable angina recurred shortly after admission, and extensive dissection of the left coronary artery was demonstrated. Medical therapy including systemic fibrinolysis was started but clinical stabilization and good long-term result was achieved only by aortocoronary bypass grafting. [less ▲]

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See detailQuantitative assessment of global and regional left ventricular function with low-contrast dose digital subtraction ventriculography.
Mancini, G. B.; Hodgson, J. M.; Legrand, Victor ULg et al

in Chest (1985), 87(5), 598-602

Few studies have compared the use of low-contrast dose digital subtraction ventriculography with conventional ventriculography for quantitative assessment of both global and regional left ventricular ... [more ▼]

Few studies have compared the use of low-contrast dose digital subtraction ventriculography with conventional ventriculography for quantitative assessment of both global and regional left ventricular function. Accordingly, 34 patients underwent conventional ventriculography using 36 ml of ionic contrast material and digital ventriculography (mask-mode) using 10 ml of contrast diluted in 10 ml of saline and injected over two seconds. Data from two patients were excluded because of ectopy during cineventriculography and from one because of ectopy during both studies. End-diastolic and end-systolic volumes were calculated from both studies by an area-length method and used to calculate ejection fractions. Regional wall motion was quantitated by the centerline method. Results of linear regression analysis demonstrated high correlations for all parameters (end-diastolic volume, r = 0.85; end-systolic volume, r = 0.93; ejection fraction, r = 0.92; quantitative regional wall motion, r = 0.90). Thus, low-contrast dose digital subtraction ventriculography provides an accurate assessment of both global and regional ventricular function and minimizes the required dose and inherent risks of contrast media. [less ▲]

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See detailTwo - dimensional echocardiographic guiding for endomyocardial biopsy
Pierard, Luc ULg; EL ALLAF, D; D'Orio, Vincenzo ULg et al

in CHEST (1984), 85

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See detailPatients with myocardial infarction and normal coronary arteriogram.
Legrand, Victor ULg; Deliege, M.; Henrard, L. et al

in Chest (1982), 82(6), 678-85

Eighteen patients who survived an acute myocardial infarction were found to have a normal coronary arteriogram. Seven patients were younger than 35 years and six were female. The myocardial infarction was ... [more ▼]

Eighteen patients who survived an acute myocardial infarction were found to have a normal coronary arteriogram. Seven patients were younger than 35 years and six were female. The myocardial infarction was nontransmural in 11 cases. The mean follow-up was 21.6 months. Eleven patients developed residual chest pain at rest early after myocardial infarction. One, treated by beta-blockers, suffered a recurrent myocardial infarction. Eight became asymptomatic, and two improved under antispastic therapy. Another patient developed a severe form of variant angina three months after myocardial infarction; she died following plexectomy. Finally, two patients experienced rare episodes of angina at rest. The stress ECG was negative in all cases. Provocative test for spasm was positive in three out of nine patients. Diffuse narrowing associated with chest pain was demostrated in two patients at angiography. Thus, myocardial infarction and subsequent normal coronary angiogram are mainly found in young female patients, and infarction is often nontransmural. Clinical evidence of vasospastic phenomena and increased vasomotor tone are found in most patients. Whenever residual chest pain is controlled by antispastic therapy, the follow-up course seems benign. [less ▲]

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