Exhaled nitric oxide in the diagnosis of asthma: comparison with bronchial provocation tests.

BACKGROUND: Bronchial provocation tests such as exercise, methacholine (MCH), and adenosine-5'-monophosphate (AMP) challenges are used extensively in the diagnosis of asthma. A study was undertaken to determine whether exhaled nitric oxide (eNO) can be used to diagnose asthma in patients with non-specific respiratory symptoms and to compare this test with conventional provocation tests. METHODS: Patients with non-specific respiratory symptoms and normal spirometric parameters were included in the study. eNO was measured and exercise, MCH and AMP challenges performed in all subjects. Patients were defined as asthmatic based on clinical follow up 24 months after testing. RESULTS: Forty patients were considered asthmatic and 45 were not. The area under receiver operating characteristic curves gave values of 0.896 for eNO, 0.781 for exercise, 0.924 for MCH, and 0.939 for AMP (p = 0.033, 0.575 and 0.085 for eNO v exercise, MCH and AMP respectively). From our data, a cut off value of NO > 7 ppb at a flow rate of 250 ml/s best differentiates between asthmatics and non-asthmatics (sensitivity 82.5%, specificity 88.9%). Optimal cut off values for other tests were exercise: deltaFEV1 > or = 10% (sensitivity 57.9%, specificity 100%); PC20-MCH: < or = 3 mg/ml (sensitivity 87.5%, specificity 86.7%); and PC20-AMP: < or = 150 mg/ml (sensitivity 89.5%, specificity 95.6%). CONCLUSIONS: Measurement of eNO can be used as a safe, simple and rapid test for the diagnosis of asthma and is as good as bronchial provocation tests.

Recovery from blast lung injury: one-year follow-up.

BACKGROUND: Blast injury to the lung is one of the devastating threats facing victims of an explosion. Although the pathogenesis of blast injury has been studied, little is known about the long-term effects on lung function in survivors. OBJECTIVE: To examine the pulmonary function of survivors 1 year after sustaining a blast injury. DESIGN: Prospective study. SETTING: Pulmonary function test laboratory at Hadassah Medical Center, Jerusalem. PARTICIPANTS: Eleven surviving victims of a blast injury sustained during a bus terrorist explosion. MEASUREMENTS: Twelve months after the injury, physical examinations, lung function tests, and progressive cardiopulmonary exercise examinations were conducted, and chest radiographs were obtained. RESULTS: The average age was 28 +/- 9.8 years. Most of the victims had multiple injuries in addition to the lung injury. Ten patients received mechanical ventilation, and 6 patients required chest drainage. All patients were treated in the ICU, with an average stay of 11.8 +/- 9 days. The patients were discharged to their homes or to a rehabilitation center 32.4 +/- 27. 3 days after the explosion. One year later, none had any pulmonary-related complaints. Physical examination of the lungs was normal. Most of the patients demonstrated normal lung function tests and complete resolution of the chest radiograph findings. CONCLUSION: Most patients who survive lung blast injury will regain good lung function within a year.

The effect of acute and chronic administration of nicotine on lipoprotein lipase activity.

Nicotine was injected intraperitoneally to rats and 2 h later lipoprotein lipase was determined in isolated perfused hearts. There was a significant increase in heparin releasable lipoprotein lipase activity which represents the functional pool without increase in total enzyme activity. When 1 microliter/h of a solution of nicotine (120 mg/ml) was delivered for 3 days from subcutaneously implanted miniosmotic pumps, total lipoprotein lipase activity in the heart increased 1.5-3.0 fold. Endogenous lipoprotein lipase activity in plasma doubled and there was a significant fall in plasma triglyceride levels. The effect of nicotine on heart lipoprotein lipase activity was evident also after 6 days of continuous delivery and was accompanied by a fall in adipose tissue lipoprotein lipase activity. No effect was seen when the dose of nicotine was halved. A positive correlation was seen between plasma nicotine levels and heart lipoprotein lipase activity, while adipose tissue lipoprotein lipase correlated negatively with plasma nicotine levels. Chronic administration of nicotine was accompanied by either weight loss or diminished weight gain. It is concluded that in the rat the acute effect of nicotine on the shift of lipoprotein lipase to the functional pool could be related to enhanced beta-adrenergic stimulation. The chronic effect of nicotine could have been mediated by the loss in body weight, due to reduced caloric intake.

Late results of multidisciplinary management of unilateral cleft lip and palate.

A model was designed for evaluating protocol and management strategies in the multidisciplinary approach to cleft lip and palate treatment. The treatment history and present status of 45 patients 14 to 22 years of age were evaluated by a plastic surgeon, orthodontist, and speech pathologist. Results indicated that only about half of these patients had completed treatment by one of the specialties by the time they were 14 years or older. Even more surprisingly, only 7 patients (16%) had completed treatment by all three specialties by this age. Factors that may contribute to this low percentage of completed treatments are discussed.

The influence of two-flap palatoplasty on facial growth in beagles.

This study was designed to test the hypothesis that palate repair in beagles inhibits overall facial growth, primarily in the transversal dimension. Direct cephalometry of the skulls at 28 weeks postoperatively showed that two-flap palatoplasty did not inhibit overall facial growth in animals with surgically created cleft lip, alveolus, and palate. In many cases, facial growth in animals with palate repair was indistinguishable from that in unoperated control animals. The unexpected finding in this study was that two-flap palatoplasty seemed to stimulate intensive new bone formation in the surgically created alveolar and palatal defects. Bony remodeling may be responsible for the enhanced anteroposterior and transversal facial growth in animals with palate repair (group 3). The results of this study validate findings from our previous studies in the rabbit model; yet caution should be employed in extrapolation of these findings to the clinical setting. For the first time, evidence is presented that in normal beagles with surgically created alveolar and palatal defects, two-flap palatoplasty stimulated substantial and, significant new bone formation in the site of the defects. Studies should be designed to determine the nature and time course of bony palatal wound healing.