American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Sep 2000
Obstructive fibrinous tracheal pseudomembrane. A potentially fatal complication of tracheal intubation.
A series of 10 consecutive cases presenting an obstructive fibrinous tracheal pseudomembrane (OFTP) as a complication of endo-tracheal intubation is presented. The patients developed a thick tubular, rubber-like, whitish pseudomembrane moulding the tracheal wall as a result of short-duration endotracheal intubation. This pseudomembrane firmly adhered to the tracheal wall at the site of the endotracheal cuff. ⋯ One patient died from acute asphyxiation. The history and the pathological findings of these cases support the hypothesis that this lesion represents an early stage of ischemic tracheal wall injury related to the cuff pressure. Pulmonary physicians should be alerted on this poorly known complication of endotracheal intubation.
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Am. J. Respir. Crit. Care Med. · Sep 2000
Increased levels of interleukin-6 are associated with lymphocytosis in bronchoalveolar lavage fluids of idiopathic nonspecific interstitial pneumonia.
Local overexpression of interleukin-6 (IL-6) experimentally induces lymphocytic infiltration in the bronchial tree of rat. Among idiopathic interstitial pneumonia (IIP), nonspecific interstitial pneumonia/fibrosis (NSIP) has an increased number of lymphocytes in bronchoalveolar lavage (BAL) fluid when compared with usual interstitial pneumonia (UIP). To reveal a relation of IL-6 with the lymphocyte infiltration of NSIP, IL-6 was measured in BAL fluids of idiopathic NSIP (n = 7), idiopathic UIP (n = 16), and normal control subjects (n = 45). ⋯ The high-UIP group had BAL lymphocytosis when compared with the low-UIP group (p < 0.05). IL-6 stained on epithelial cells of the bronchial tree and on alveolar macrophages of NSIP and UIP. In conclusion, the lymphocytosis in BAL fluid of patients with NSIP and a subgroup of UIP is associated with the high levels of IL-6 and its sources are the epithelial cells of the small airway and the alveolar macrophages.
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Am. J. Respir. Crit. Care Med. · Sep 2000
Comparative StudyRisk factors for pediatric asthma. Contributions of poverty, race, and urban residence.
The Child Health Supplement to the 1988 National Health Interview Survey was used to examine parent-reported current asthma among a nationally representative sample of 17,110 children zero to 17 yr of age. Numerous demographic variables were analyzed for independent associations with asthma using modified stepwise logistic regression, with models including specific combinations of risk factors. ⋯ Similarly, compared with nonurban, nonpoor children, urban and poor (adjusted OR = 1.44, 95% CI = 1.05 to 1.95), urban and nonpoor (adjusted OR = 1.22, 95% CI = 1.004 to 1.48), urban children, both poor and nonpoor, were at significantly increased risk of asthma, whereas nonurban poor children were not: nonurban and poor (adjusted OR = 1.03, 95% CI = 0.72 to 1.48). These results suggest that the higher prevalence of asthma among black children is not due to race or to low income per se, and that all children living in an urban setting are at increased risk for asthma.
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Am. J. Respir. Crit. Care Med. · Sep 2000
Frequent genetic alterations at the microsatellite level in cytologic sputum samples of patients with idiopathic pulmonary fibrosis.
Idiopathic pulmonary fibrosis (IPF) is a disease of unknown etiology associated with DNA damage and malignancy. Bronchogenic carcinoma is the cause of death in 10% to 13% of IPF patients. Microsatellite instability (MSI) and loss of heterozygosity (LOH) are frequently detected in cancers. ⋯ None of the healthy subjects exhibited genetic alterations in the studied markers. No correlation was found between the detected genetic alterations and age, disease duration, blood gases, or spirometric parameters of the patients. Our findings suggest that the genetic alterations that we studied are frequent in IPF, are apparently unrelated to the severity of the disease, and may be related to tumorigenesis.