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  • 1
    ISSN: 1432-1084
    Keywords: Key words: Lung – Asthma – Bronchi – Hyperresponsiveness – CT – Expiratory CT – Air trapping
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to evaluate bronchial and lung abnormalities in patients suffering from moderate asthma as defined by international guidelines, with special attention to air trapping on CT in comparison with that detected in smoking and non-smoking normal subjects. Twenty-two patients classified as moderate asthma and control subjects including healthy volunteers, smokers (n = 10) or non-smokers (n = 12) were prospectively explored by high-resolution CT (HRCT) performed at suspended full inspiration and expiration. The same expiratory protocol was performed 15 min after inhalation of 200 μg of salbutamol. Patients underwent pulmonary function tests within the same week and bronchodilator response was assessed following inhalation of salbutamol. Abnormalities of bronchi and lung parenchyma on inspiratory CT and air trapping on expiratory CT, in dependent and non-dependent areas, were assessed and scored semi-quantitatively by two independent observers. Comparison of score mean values between the different groups was performed using Mann-Whitney test and Spearman correlation between CT findings and pulmonary function tests were calculated. Mosaic perfusion was observed in 23 % of asthmatics. Air-trapping scores were significantly higher in asthmatic patients than in non-smoking control subjects (p = 0.003), but not than in smokers. This difference was ascribed to non-dependent zones of the lung for which air-trapping scores were also higher in asthmatic patients (p = 0.003) and in smoking subjects (p = 0.004) than in normal controls. In the asthmatic group, a significant positive correlation was found between airways resistance and bronchial dilatation score (p = 0.01), and between small airways obstruction index and mosaic perfusion score (p = 0.05). In addition, both FEV1 and reversibility of small airways obstruction values correlated with air-trapping score (p = 0.03 and p = 0.007, respectively). No change could be detected in air-trapping score following salbutamol inhalation. Patients suffering from moderate asthma present mosaic perfusion and larger areas of air trapping than normal subjects, particularly in non-dependent areas of the lung. These lung abnormalities are related to small airways obstruction.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1398-9995
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:  To improve asthma control, the management of rhinosinusitis often leads the physician to perform sinonasal imaging and/or nasal endoscopy, but their respective contributions are still insufficiently understood.Objective:  To evaluate the potential contribution of a symptoms questionnaire, sinus radiography (SR) and computed tomography (CT) scan to the diagnosis of nasal diseases in asthmatic patients when compared with ENT examination.Methods:  A total of 124 patients completed a questionnaire on nasal symptoms administered by the chest physician. Then, they underwent ENT examination. On the same day, SR and CT scans were performed independently.Results:  Patients (80.3%) had nasal symptoms during the month preceding the consultation. The ENT examination was normal in 8.1% (n = 10) and revealed rhinitis in 57.3% (n = 71), rhinosinusitis in 14.5% (n = 18) and nasal polyposis in 20.2% (n = 25). For rhinitis, the negative predictive value of bilateral nasal obstruction was 87.8%. Both SR and CT had low sensitivity and specificity. For rhinosinusitis, the negative predictive value of nasal symptoms varied from 85.4 to 95.2%. Sinus CT was at least as accurate as SR for the diagnosis of rhinosinusitis. In a multivariate analysis, only the CT scan (score ≥12) appeared to be significantly associated with the diagnosis of nasal polyposis.Conclusion:  In asthmatic patients, physicians need to enquire systematically about the existence of nasal symptoms by using this simple questionnaire which is sensitive for rhinitis, and has good negative predictive value for excluding rhinosinusitis and nasal polyposis.
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  • 3
    ISSN: 1398-9995
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: This study was designed to examine the effect of passive sensitization (PS) on human bronchial mast cells. PS with asthmatic serum induces a hyper-responsiveness to nonspecific agonists, and immunoglobulin (Ig)E binding mainly on mast cells.Methods:  Bronchi dissected out from 19 lung specimens were incubated in normal or asthmatic serum. Immunohistochemistry was performed using monoclonal antibodies (MoAbs) directed against tryptase, chymase, or c-kit. Mast cells were classified as fully granulated (type I), partly (type II) or largely degranulated (type III). Tryptase was measured in supernatant using ELISA. Contractile response was recorded in a separated set of experiments using an organ bath system.Results:  PS decreased both tryptase positive cells (47.9 ± 10.0 vs. 26.7 ± 4.8 cell/mm2, P = 0.003) and chymase positive cells (26.1 ± 3.3 vs. 14.9 ± 1.8 cell/mm2, P = 0.01), but did not alter the number of c-kit positive cell. PS decreased the proportion of type I (55.4 vs. 28.9%, P 〈 0.0001) and, concomitantly increased that of types II (23.2 vs. 41.0%, P 〈 0.0001) and III (21.4 vs. 30.1%, P = 0.04). Following PS, tryptase concentration significantly increased and the magnitude of histamine response, was correlated with the amount of type II mast cells.Conclusion:  PS of human isolated bronchi induces a mast cell degranulation related to in vitro hyper-responsiveness, along with a tryptase release.
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  • 4
    ISSN: 1365-2222
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background Immunoglobulin E (IgE) plays an important role in asthma, with total serum IgE levels closely related to both clinical expression of the disease and airway hyperresponsiveness. IgE binds to a high affinity cell-surface receptor (FcεRI) which is present on mast cells and which has also recently been demonstrated on cutaneous dendritic cells. If pulmonary dendritic cells were also able to express this receptor, this would have important implications with regard to their potential role in asthma.Objectives The aims of the study were to investigate the expression of the α subunit of the high affinity IgE receptor (FcεRI-α) in normal and asthmatic airways, and to analyse its cellular provenance with particular emphasis on the dendritic cell.Methods Bronchial biopsy specimens were obtained using fibreoptic bronchoscopy from 10 atopic asthmatics and nine non-atopic non-asthmatic control subjects. Specimens were processed into glycolmethacrylate resin and analysed by immunohistochemistry using specific monoclonal antibodies against FcεRI-α. and against tryptase and CDla. markers for mast cells and dendritic cells, respectively.Results The numbers of dendritic cells were significantly higher in the airways of asthmatics compared with those of control subjects (P〈0.02). Analysis of sequential sections revealed that the α subunit of FcεRI was localized to both mast eells and dendritic cells. The proportion of dendritic cells expressing FcεRI-α was significantly inereased in the asthmatic group (P 〈 0.003).Conclusion These results support the hypothesis that dendritic cells play an important role in allergic asthma although the functional significance of FcεRI-α expression needs further investigation.
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  • 5
    ISSN: 1365-2222
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Arachidonic acid (AA)-induced chemiluminescence (CHL) was studied in vitro by means of a luminometer in platelets from nine healthy volunteers and six allergic patients. The amplitude of the CHL signal increased with AA concentration from 250 μM to 7 mm. At a low AA concentration (250 μm), the CHL signal consisted of two peaks. The first one occurred at 6±3 sec and the second one at 90±15 sec (n= 9). The mean amplitude of these peaks was 1.95±0.61 mV/sec and 0.82±0.22 mV/sec for normal subjects, and 2.35±0.62 mV/sec and 0.78±0.26 mV/sec for allergic patients, respectively. Aspirin (a cycloxygenase inhibitor) and baicalein (a lipoxygenase inhibitor) reduced in a concentration-dependent manner, the first and second peak, respectively. The binding of immunoglobulin E (IgE) alone to platelets from both normal and allergic subjects inhibited both the first and second peak of AA-induced CHL. This inhibitory effect was specifically due to the action of IgE as it was (i) concentration-dependent and (ii) not observed when immunoglobulin G (IgG) was substituted for IgE. It is concluded that in normal subjects, as well as in allergic patients, the binding of IgE alone to its specific receptor on human platelets could alter arachidonate metabolism that probably involves cycloxygenase and lipoxygenase pathways.
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