Comparative study of PEP mask and Flutter on expectoration in cystic fibrosis patients.

The objective of the study was to investigate the effect of positive expiratory pressure (PEP) and Flutter on expectoration in cystic fibrosis (CF) patients. Data was gathered through 260 treatments with 10 patients (5 female; 19.2 years; BMI: 18.0). Two methods were used alternately, first the patients started with Flutter and proceeded with PEP, and the next occasion they exercised in the reverse order, starting with PEP then continuing with Flutter. During each phase, 5 sets of 10 exhalations were performed. Sputum weight was measured after the use of the first device, and at the end of the treatment. During sessions starting with Flutter 4.0 ± 4.0 g sputum was expectorated, continuing with PEP, an additional 5.2 ± 5.0 g was produced, altogether 9.2 ± 8.2 g. At sessions starting with PEP 7.4 ± 3.7 g was expectorated, continuing with Flutter an additional 0.8 ± 1.4 g, that is 8.2 ± 4.1 g. Comparing the two devices by themselves, PEP proved to be significantly more efficient then Flutter. Comparing the two treatment types it is statistically not proven, which one is preferable using both devices. Conclusively, PEP is significantly more efficient than the Flutter in sputum expectoration among CF patients. The Flutter is a useful supplementary device.

Exhaled carbon monoxide concentration increases after exercise in children with cystic fibrosis.

Oxidative stress and hypoxia, which may occur in cystic fibrosis patients (CF) at rest and may be worsened by exercise, induce the expression of heme oxygenase (HO)-1, resulting in increased carbon monoxide (CO) formation. We tested that exhaled CO level (eCO) was higher in CF patients than in healthy subjects, and that exercise increased CO production. Exhaled CO was measured electrochemically in 15 CF patients and 15 control subjects at rest (T0), immediately (T1) and 60 minutes after a symptom-limited incremental bicycle exercise test (T60). Arterial oxygen saturation (TcO2) was monitored transcutaneously. Data are given as mean+/-SEM. Baseline eCO was 1.90+/-0.26 ppm in the control and 1.93+/-0.27 ppm in the CF group. In both groups eCO was lower at T1 than at rest. In the control group eCO was also low at T60, but in the CF group it was increased compared to baseline level at this timepoint. Exercise caused oxyhemoglobin desaturation in CF patients which was related to the increase in eCO measured at T60 (r=0.67, p<0.01). Our findings suggest that exercise modulates the level of exhaled CO partly by worsening oxygenation in CF patients.

Diagnostic value of urinary enzyme determination in renal transplantation.

The measurement of enzyme activity in urine provides a sensitive assessment for renal tubular cell damage. The present study was undertaken to evaluate the clinical value of the determination of tubular brush-border-associated enzymes, alkaline phosphatase (AP), gamma-glutamyl transferase (GGT), leucine aminopeptidase (LAP), and dipeptidyl peptidase IV (DPP), of patients with normal graft function (NOR, n = 20), with acute tubular necrosis (ATN, n = 11), with an acute rejection episode (ARE, n = 17) after transplantation, and of healthy persons (n = 20). The second urine of the morning was collected daily during the patients' stay in hospital. The enzyme activities were measured at 25 degrees C and were expressed as U/mmol creatinine. The enzymuria in NOR is higher than in healthy controls, but is still in the normal range. By 5 days after transplantation the initial increased excretion declines as the graft function improves. Elevated enzymuria (DPP 0.69 +/- 0.56, AP 3.06 +/- 3.24, GGT 4.16 +/- 4.13, and LAP 1.39 +/- 1.27) was observed during the rejection episodes. Two days before clinical diagnosis of rejection, the release of DPP-IV and GGT increases to double, and the AP and LAP increases to 3 times the value on the fourth day before rejection. Successful treatment of rejection coincided with a quick return by the third day of the rejection period to the previous enzyme distribution. In ATN no decrease of enzymuria occurs and the excretion is much higher than in ARE. Our method with the every day monitoring of kidney graft function offers the possibility for the early diagnosis of acute rejection.

Disseminated Kaposi sarcoma in immunosuppressed patients.

UNLABELLED: Tumour incidence was examined in kidney-transplanted patients receiving immunosuppressive therapy. Eight hundred and fifty immunosuppressed patients (mean age: 34.5 years; mean follow-up time: 67 months; men/women = 3/2), were followed up. Two cases of disseminated visceral kaposi sarcoma (K.S.) are reported in detail. RESULTS: long-term immunosuppression significantly raises the risk of tumour development (30/850); one must reckon with the appearance of visceral K.S. (2/850), which is exceptionally rare in the general population. CONCLUSION: the classical lower extremity cutaneous manifestation is fairly benign, it appears later and responds to radiotherapy well. The visceral form appears early (in 3-6 months), it is aggressive, progressing quickly. Only early diagnosis followed by immediate reduction or discontinuation of immunosuppression, helps successful oncological treatment.