Bronchoalveolar glutathione and nitrite/nitrate in idiopathic pulmonary fibrosis and sarcoidosis.

BACKGROUND AND AIM OF THE WORK: Bronchoalveolar lavage (BAL) is useful in diagnosis and management of interstitial lung diseases. Glutathione (GSH) represents an important defence molecule against reactive oxygen species produced during inflammation, which underlies both idiopathic pulmonary fibrosis (IPF) and sarcoidosis. Nitric oxide has been suggested as a marker of airway inflammation. The aim of this study was to examine the content of GSH and NO stable metabolites, nitrite/nitrate, in the BAL of a group of patients with IPF and sarcoidosis. METHODS: BAL was performed in 13 patients with newly diagnosed IPF, 13 patients with sarcoidosis and 4 controls. Total GSH and nitrite/nitrate were measured. BAL was repeated, in 5 patients with IPF, after 6 and 12 months and GSH was measured again. RESULTS: IPF patients had significantly lower levels of total GSH compared to sarcoidosis patients or controls (129 +/- 22 vs. 324 +/- 40 and 383 +/- 23 mM; p < 0.001) in the epithelial lining fluid (ELF). In patients with IPF (n = 5), total GSH levels in the ELF increased after 6 and 12 months (T0 = 98 +/- 19; T6 = 219 +/- 22; T12 = 301 +/- 34 microM; p < 0.05) following therapy with immunosuppressive drugs such as corticosteroids, methotrexate, cyclosporin A. Levels of nitrite/nitrate were found significantly elevated in IPF (n = 8) and sarcoidosis (n = 10) patients compared to controls (230 +/- 37 and 216 +/- 36 vs. 86 +/- 11 microM; p < 0.05). CONCLUSION: These observations support the role of inflammation and antioxidant defences in interstitial lung diseases and may provide insights into the pathogenesis of oxidant-induced interstitial disease and their therapy.

Microperimetry of localized retinal nerve fiber layer defects.

The aim of this study was to determine the sensitivity of retinal areas involved in a localized retinal nerve fiber layer (RNFL) defect and to assess correlations between microperimetry and the standard full threshold central 30 deg visual field test. Twenty-five patients with focal RNFL defects, evaluated by means of Argon-blue scanning laser ophthalmoscopy (SLO), underwent an automated 30 deg central visual field examination and a microperimetry with SLO. Microperimetry was performed according to standard procedures (infrared laser for fundus imaging; HeNe laser for 10 candles/m2 background illumination, fixation aid and generation of stimuli; manual fundus tracking). The size of stimuli was Goldmann III with 0.1 sec duration. In eyes with focal RNFL defects a deep microperimetric scotoma of at least 5 dB was found in 12 cases and a mild scotoma (1-4 dB) in 13 cases. These scotomas were mainly located throughout the whole defect or grouped in the temporal or nasal sides of the defect and were characterized by sharp and well-defined borders. With automated perimetry, a scotoma, defined by a single point depression of at least 10 dB or a depression of at least 5 dB in two or more contiguous points corresponding to the RNFL, defect, was found in only 14 out of 25 eyes with microperimetric defect. Focal RNFL defects correspond to localized areas of depressed retinal sensitivity as evaluated by microperimetry. The close correspondence between structural and microperimetric findings suggests that, in hypertensive eyes also, localized RNFL defects correspond to visual dysfunction possibly associated with substantial atrophy of ganglion cells.

Evaluation of the efficacy and toxicity of the cyclosporine A-flucortolone-methotrexate combination in the treatment of sarcoidosis.

Eleven patients with chronic sarcoidosis resistant to high-dose corticosteroids and other immunosuppressive treatments were treated with cyclosporine A at the initial daily dose of 5 mg per kg body weight (ideal weight in the case of overweight subjects) combined with flucortolone and methotrexate. A complete and lasting remission of the disease was obtained in all patients with total disappearance of pulmonary and extrapulmonary manifestations. In addition, the disease activity indexes normalized and remained normal for the rest of the follow-up period (24.82 +/- 8.22 months, range 12-33). No renal or hepatic toxicity was observed in any patient. Two of them presented hypertrichosis and one nausea.

Aspecific bronchial hyperreactivity in pulmonary sarcoidosis.

Aspecific bronchial hyperreactivity (A.B.H.) is a condition found mostly in cases of bronchial asthma, but it may also present in other pathologies affecting the respiratory tract. This study examines 30 patients presenting hilo-pulmonary sarcoidosis, 27 asthmatic patients and 25 healthy subjects as controls. The three groups were sex and age matched. No significant difference in smoking habits between controls and sarcoidosis patients was found. Patients were tested for aspecific bronchial hyperreactivity by administering increasing doses of methacholine. Methacholine inhalation was performed following a dosimetric method. Aspecific bronchial hyperreactivity was found in 6 (20.6%) of sarcoidosis patients with a significant frequency (p < 0.05). No statistically significant difference was found for mean PD20FEV1 values, but the difference between asthma and sarcoidosis patients was highly significant (p = 0.003). No statistically significant difference was found between basal FEV1 means expressed as a percentage of the former in asthmatics and sarcoidosis patients, both responsive and unresponsive. Although it is difficult to draw conclusions from these findings, aspecific bronchial hyperreactivity was seen to increase in subjects with sarcoidosis, and this may explain the not rare association between asthma and sarcoidosis.

[Mycoplasma pneumoniae pneumonia. Can radiologic features suggest the etiologic agent?]. / La polmonite da Mycoplasma pneumoniae. Gli aspetti radiologici possono indirizzare verso l'agente eziologico?

The present study was aimed at evaluating whether Mycoplasma pneumoniae (MP) pneumonia presents with typical X-ray patterns which can help its diagnosis. The chest films of 32 adult patients with serologically proven MP infections were reviewed. Confluent or patchy consolidation was the most common finding (66% of patients), interstitial involvement was much less frequent (19%), and so were "mixed" patterns (15%). Unilateral involvement was common (69%), the lower lobes were frequently involved (52%) and in 78% of cases only one lobe was affected. Pleural fluid (40%) and atelectasis (31%) were commonly seen, while hilar adenopathy was rare (9%). In substantial agreement with previous studies, no distinctive X-ray pattern of MP pneumonia was found and marked differences were seen to exist in its radiographic appearance. Despite these obstacles, some characteristic X-ray findings were suggestive of MP pneumonia: diffuse/localized interstitial involvement appeared to be the most helpful sign, in combination with clinical and epidemiologic data. On the contrary, patchy and acinar consolidations are slightly suggestive of MP etiology.