Genetic polymorphisms of CYP1A1 and GSTM1 and lung cancer risk.

Susceptibility to lung cancer may, in part, be determined by interindividual differences in the cytochrome P450-catalysed bioactivation and the glutathione S-transferase-catalysed detoxification of procarcinogens. Therefore a lung cancer case-control study was set up to investigate the association of three polymorphisms of the CYP1A1 gene (CYP1A1*2A, CYP1A1*2B, CYP1A1*4) and GSTM1*0 genotype with lung cancer risk in Austrian Caucasians. Genomic DNA was isolated from the peripheral blood lymphocytes of 134 male lung cancer patients and 134 age-matched controls with nonmalignant conditions and PCR-based analyses were performed. There was no significant difference in risk between cases and controls, either for the CYP1A1*2A (OR=1.09, 95%CI=0.46-2.58), CYP1A1*2B (OR=1.09, 95%CL=0.46-2.58) or for the CYP1A1*4 polymorphism (OR=0.49, 95%CL=0.20-1.16). The prevalence of the GSTM1*0 genotype in the lung cancer group (47.8%) was comparable to that found in the control group (49.3%) and also had no effect on lung cancer risk (OR=0.94, 95%CL=0.54-1.57). Further, in a subgroup of male ever-smokers (n=126), no significant influence on the relative risk was found for these polymorphisms. Our results suggest that these investigated polymorphisms can not be considered as genetic susceptibility markers for lung cancer within the Austrian Caucasian population.

Pleural effusions in human immunodeficiency virus-infected patients. Correlation with concomitant pulmonary diseases.

The objective of our study was to evaluate the prevalence of pleural effusions in patients with the acquired immunodeficiency syndrome, to correlate these effusions with any concomitant pulmonary diseases and to evaluate the role of cytologic examination in the diagnosis of the effusions. Twenty-eight of 389 (7.2%) human immunodeficiency virus-infected patients had pleural effusions and 27 of the 28 were suffering from concomitant pulmonary diseases. Those diseases were bacterial pneumonia (9), mycobacterial infection (7), non-Hodgkin's lymphoma (4) and Kaposi's sarcoma (2). Pneumocystis carinii pneumonia was diagnosed in two patients, and cytomegalovirus pneumonitis and pulmonary aspergillosis and small cell carcinoma in one patient each. Cytologic examination of pleural effusions provided conclusive diagnoses of mycobacterial infection in 2 of the 7 patients, of non-Hodgkin's lymphoma in 4 and of P carinii infection in 2.

[Idiopathic CD4+ T-lymphocytopenia in 2 patients without indications for HIV infection]. / Idiopathische CD4+ T-Lymphozytopenie bei zwei Patienten ohne Hinweis auf eine HIV-Infektion.

We report on two patients with idiopathic CD4+ T cell depletion. A 26 year-old woman presented to us with acute respiratory failure requiring mechanical ventilation. Despite combined antibiotic therapy parenterally the opacities increased in the chest X-ray. An open lung biopsy was performed and led to the histological diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP). Respiratory function was improved impressively by high dose parenteral cortisone administration. This patient showed a general lymphocytopenia with severe CD4+ T cell depletion (60(37%)/mm3 blood). The CT4+ T cell concentration increased during a follow up period of 14 months, but did not reach normal values. The second patient was a 33 year-old homosexual. He was admitted with a mucocutaneous fungal infection which was successfully treated by antifungal drugs. This patient demonstrated a transient CD4+ T cell depletion (350(32%)/mm3 blood). In both patients HIV type 1 and 2 infections were excluded by antibody- and p 24-antigen testing, polymerase chain reaction and virus culture. CONCLUSION. Idiopathic CD4+ T lymphocytopenia differs from HIV infection in immunological profile, in the tendency to reversal of the CD4+ T cell depletion over time and in its better prognosis. It is unclear if this is a new syndrome and whether a transmissible agent, or possibly a genetically-determined reaction to noxious agents is responsible.

Is there a right age for case finding in elderly people?

If age is a useful basis for determining a screening policy the benefit of the resulting interventions should vary with age. The choice of the screening age will be such as to maximize the benefit. Data from a study of the screening of elderly people by a Health Visitor produced no evidence to support the choice of 75 as minimum age for screening in primary care. Indeed there was a suggestion that age might be more useful as a maximum rather than a minimum criterion.

[Contribution of nuclear medicine to management of pulmonary complications in patients with acquired immune deficiency]. / Beitrag der Nuklearmedizin zum Management pulmonaler Komplikationen bei Patienten mit erworbener Immunschwäche.

Opportunistic lung infections and malignancies are life-threatening complications in HIV-positive patients. In 72 HIV-positive patients the role of different non-invasive tests such as lung function tests, blood gas analysis, 67 gallium scanning and epithelial lung clearance with 99m Tc-DTPA for the management of these patients was prospectively studied. For all non-invasive tests the mean values of patients with pulmonary complications (n = 25) differed significantly from those of asymptomatic HIV-positive patients (n = 47) (p < 0.001). In 10 patients presenting with acute Pneumocystis carinii pneumonia, 99m Tc-DTPA clearance rates and 67 gallium uptake differed significantly before and after therapy (4.80 +/- 1.23%/min vs 2.47 +/- 0.72%/min and 2.15 +/- 0.42 vs 1.39 +/- 0.18, respectively). Follow-up after therapy revealed different time courses of these tests for normalization. A significant inverse correlation was found between DLCO and 99m Tc-DTPA lung clearance (r = -0.90, p < 0.001, n = 35). A diffuse homogeneous 67 gallium uptake is not diagnostic for PCP, the same pattern was found in a patient with lymphoid interstitial pneumonitis and in patients with CMV pneumonitis; these patients also had accelerated epithelial lung clearance rates. 67 gallium (6/6) was superior to 99m Tc-labelled immunoglobulin G (3/6) for detection of PCP. The 3 patients with Kaposi sarcoma of the lung had negative 67 gallium scans, but positive 201 thallium scans and increased 99m Tc-DTPA clearance rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Can health visitors prevent fractures in elderly people?

OBJECTIVES: To assess whether intervention by a health visitor could reduce the number of fractures, over a four year period, in those aged 70 and over. DESIGN: Randomised, controlled trial; randomisation by household. SETTING: General practice in a market town. SUBJECTS: Of 863 patients aged 70 and over on the practice records, 674 were traced and successfully interviewed; 350 were assigned to the intervention group, 324 as controls. INTERVENTION: The people in the intervention group were allocated to the care of a health visitor. The approach was four pronged: assessment and correction of nutritional deficiencies, including reducing smoking and alcohol intake; assessment and referral of medical conditions such as heart block or inappropriate medication; assessment and correction of environmental hazards in the home such as poor lighting; assessment and improvement of fitness--for example, exercise classes for the moderately fit. The intervention continued for four years. MAIN OUTCOME MEASURE: Fracture rate over four years. RESULTS: The incidence of fractures was 5% (16/350) in the intervention group and 4% (14/324) in the control group (difference not significant). CONCLUSIONS: A health visitor visiting a group of people aged 70 and over and using simple preventive measures had no effect on the incidence of fractures.

[Differential diagnosis of ascites and abscess forming hepatitis in AIDS patients with reference to the first patient with microsporidia infection in Austria]. / Zur Differentialdiagnose des Aszites und der abszedierenden Hepatitis bei AIDS-Patienten anhand des ersten Patienten mit Mikrosporidieninfektion in Osterreich.

We report on a 30 years-old female AIDS patient suffering from generalized pneumocystosis and intestinal microsporidiosis. The chest X-ray showed a right-sided pleural effusion; the lungs showed no areas of consolidation and the heart and the vessels were normal in size. Sonography revealed multiple cystic lesions of the liver measuring 1-3 cm in diameter, as well as ascites. Pneumocystis carinii was detected on cytological examination of the bronchoalveolar lavage fluid, the pleural effusion and the ascitic fluid. Intestinal microsporidiosis was diagnosed by cytological examination of the stool. Both pneumocystis carinii infection and microsporidiosis may cause hepatitis and ascites. In our patient the organ manifestations of the two infections did not overlap. Since simultaneous organ manifestations are possible the differential diagnosis is discussed. This is the first case of microsporidiosis reported in Austria.

Induced sputum and cytological diagnosis of lung cancer.

Diagnosis of lung cancer by examination of induced sputum specimens for malignant cells may be a valuable alternative to diagnosis by bronchoscopy. Patients suspected of having lung cancer were recruited and randomly distributed into two groups, one group (n = 34) having sputum induced by use of an ultrasonic nebuliser before bronchoscopy, and the other (n = 33) undergoing ordinary expectoration before bronchoscopy. 25 patients in the induced-sputum group were diagnosed as having primary lung cancer; induced sputum was positive for malignant cells in 21 of these patients (84%), whereas bronchoscopy was positive in 23 (92%) (not significantly different). In comparison, ordinary sputum was positive in 15 of 29 patients (52%) diagnosed as having primary lung cancer, whereas bronchoscopy was positive in 28 (97%) (p less than 0.001). Induction of sputum by an ultrasonic nebuliser was an effective procedure for diagnosis of primary lung cancer.

[Differential diagnosis of necrotizing sarcoid angiitis: necrotizing sarcoid angiitis and collagen disease--a case report]. / Zur Differentialdiagnose der nekrotisierenden sarkoidalen Angiitis: Nekrotisierende sarkoidale Angiitis und Kollagenerkrankung--Ein Fallbericht.

The chest x-ray showed a bilateral micronodular pattern and hilar lymph nodes. Lung function test revealed a diminished VC, TLC and a reduced compliance and CO diffusion capacity. The histological examination of the lung biopsy showed sarcoid-like necrotising granulomatous formations of the vessel walls and destruction of these. Unusual was the coincidence of a sarcoidal necrotizing angiitis and a connective tissue disease which presented as Raynaud's disease. Antinuclear antibodies and antibodies against SSA-RO and Scleroderma 70 were identified. The histological examination of the skin biopsy showed changes pertaining to scleroderma. In accordance with the definition by Laevitt (4, 5), this disease is a polyarteritis overlap syndrome.

[Wegener's granulomatosis with splenic involvement and Hashimoto's lymphomatous thyroiditis]. / Wegenersche Granulomatose mit Milzbeteiligung und Thyreoiditis lymphomatosa Hashimoto.

A case of a 37-year old female patient suffering from Wegener's granulomatosis is reported. The chest x-ray showed a tumorous consolidation of the right upper lobe and of the apical segment of the right lower lobe. The histological examination of the lung, the kidney and the spleen revealed necrotising granulomas typical of Wegener's granulomatosis. Additionally, a thyroiditis lymphomatosa Hashimoto was diagnosed. So far, coincidence of thyroiditis Hashimoto and Wegener's granulomatosis has not been reported in the literature. The involvement of the spleen was a rare manifestation of Wegener's granulomatosis.

[Results of preventive screening of chimney sweeps]. / Ergebnisse von Vorsorgeuntersuchungen bei Rauchfangkehrern.

In a prospective study, 18 chimney sweeps aged between 21 and 57 years were examined with the aim of detecting the presence of heavy metals in the blood and urine, and identifying cardiopulmonary diseases. Elevated concentrations of cadmium were found in three cases, and of lead in two cases, the concentrations being such that damage to health could not be excluded. None of the chimney sweeps showed any signs of bronchial hyper-reactivity or coronary heart disease. With respect to risk factors for coronary heart disease, elevated cholesterol and/or triglyceride levels were observed in 7/16 patients. These figures are compatible with the average figures for the Austrian population at large.

Smoking prevention among people aged 60 and over: a randomized controlled trial.

This study aimed to test the hypothesis that people aged 60 and older respond to assistance in stopping smoking. Using a single general practitioner visit backed up by a practice nurse, 14% of the smokers had discontinued the habit 6 months after the intervention period. The intervention group also showed some improvements in a standardized measure of breathlessness.

Serum neuron-specific enolase is a useful tumor marker for small cell lung cancer.

Small cell lung cancer (SCLC) may be potentially curable. A correct diagnosis of cancer cell type is important and serum markers are of great value. Although several markers have been suggested, they have been of limited value because of insufficient specificity. To assess the value of serum neuron-specific enolase (S-NSE) as a possible marker of SCLC, the serum levels of 81 patients with SCLC (59 patients with extensive disease and 22 patients with limited disease) were compared with the serum levels of patients with non-small cell lung cancer (N-SCLC) and 93 patients with nonmalignant lung diseases. The S-NSE level also was measured in 104 patients with extensive disease of various other malignancies, including 71 solid tumors and 33 malignant hematologic disorders. From 105 healthy control subjects, the upper limit of the normal range (x + 2 standard deviations [SD]) was determined as 12.3 ng/ml. The S-NSE level was elevated in 78% of patients with SCLC, including 11 of 22 (50%) with limited disease and 52 of 59 (88%) with extensive disease. In contrast, the S-NSE level was raised only in 18% of patients with advanced N-SCLC (nine of 50) and 6% of patients with nonmalignant lung diseases (six of 93). Twelve patients (17%) with other solid malignant tumors and two patients (6%) with malignant hematologic disorders had raised S-NSE levels. Serial N-NSE levels were obtained in 13 patients with SCLC. S-NSE levels fell in all patients responding to chemotherapy and increased again with progression of disease. Our results indicate that S-NSE seems to be specific for SCLC (85%), whereas sensitivity seems to be dependent on the stage of disease. Further, S-NSE may be a useful marker for monitoring treatment and predicting relapse in patients with SCLC.

[Prevalence of malignancy in preoperatively undetermined solid round lesions]. / Malignomprävalenz präoperativer ungeklärter solitärer Rundherde.

We report on 20 patients submitted to surgery, with an average age of 53.9 years (+/- 8.8), in whom solitary pulmonary nodules were not amenable to preoperative diagnosis on the basis of biopsy material. It was shown that 35 per cent of the unclear solitary lesions were malignant. Provided that the medical risks of surgery can be justified, surgical clarification via a thoracotomy in patients in this age group is indicated.

[Immunocytochemical studies in the diagnosis of pulmonary histiocytosis X]. / Immunzytochemische Untersuchungen in der Diagnostik der pulmonalen Histiocytosis X.

The diagnostic value of immunocytochemical tests was analysed for 19 cases of pulmonary histiocytosis X (PHX) and eight of other types of fibrosing pulmonary disease (sarcoidosis, 3; exogenous allergic alveolitis, 3; chronic pneumonia, 1; fibrosing alveolitis, 1). The cellular, proliferative-fibroblastic and fibrocystic stages in the course of pulmonary changes were differentiated. PHX cells reacted with anti-S 100 protein in all stages. In three cases for which unfixed tissue was available, all PHX cells reacted with antibody Leu-6, and 35% of these cells also reacted with the proliferation marker Ki-67. The few S-100 positive cells from the eight controls were limited to peribronchial tissue. Thus the antibodies Leu-6 and S-100 are useful aids in the diagnosis of PHX.