Transbronchial lung biopsy in pulmonary sarcoidosis. Is it an evaluable method in detection of disease activity?

To assess the value of transbronchial lung biopsy in the evaluation of disease activity in pulmonary sarcoidosis, lung biopsy specimens obtained from 37 patients with this disease and their cellular patterns of bronchoalveolar lavage were studied. Morphologic analysis has showed peculiar lesions: predominant interstitial alveolitis consisting of mononuclear cells and scattered neutrophils, and eosinophils, diffuse in 13 cases and focal in 11 cases, interstitial nodular clusterings of mononuclear cells (five cases), diffuse intraalveolar infiltration of macrophages (one case), granulomas (27 cases), hyaline membranes (one case), intraalveolar (two cases) and interstitial (six cases) fibrosis, and finally cuboidal metaplasia of alveolar lining cells (eight cases). Hyaline membranes were always combined to a diffuse alveolitis consisting of some neutrophils. Only diffuse alveolitis was significantly associated with a high lymphocytosis in BAL (p less than 0.05).

Prognostic significance of the evaluation of bronchoalveolar lavage cell populations in patients with HIV-1 infection and pulmonary involvement.

To investigate the prognostic utility of the morphologic and immunologic evaluation of BAL cell populations in determining mortality risk, we analyzed BAL data obtained from 115 patients infected with HIV-1. Forty fatal outcomes occurred within 73 patients with OI. The OI patients who died showed a significant increase in neutrophils with respect to surviving patients. Furthermore, the finding of a BAL neutrophilia in HIV-1-infected patients with OI strongly correlated with a high risk of death. Among 42 cases without OI, 11 patients died. Patients without OI who had a fatal outcome showed an increase in CD3+ and CD8+ BAL lymphocytes with respect to the survivors. The presence of a lymphocytic alveolitis was associated with a significant increase in the mortality rate. Taken together our data suggest that the evaluation of the BAL cell populations might be useful in predicting the risk of fatal outcome in patients with HIV-1 infection.

Acute lung inflammation: neutrophil elastase versus neutrophils in the bronchoalveolar lavage--neutrophil elastase reflects better inflammatory intensity.

OBJECTIVE: To test the hypothesis whether PMN-Elastase in bronchoalveolar lavage fluid (BALF) could reflect neutrophil activity in the lower respiratory tract. DESIGN: Prospectively, morphologic findings of acute and chronic inflammation in the transbronchial lung biopsy specimens were compared with the numbers of neutrophils in the BALF and the concentration of PMN-Elastase in the same. SETTING: Ambulatory outpatient service of bronchology and respiratory physiopathology and intensive care unit of a communal hospital. PATIENTS: 50 ambulatory outpatients and 10 critically ill patients of the ICU, presenting infiltrative lung diseases. INTERVENTIONS: Transbronchial lung biopsies and bronchoalveolar lavage were performed through a fiberoptic bronchoscope. Venous blood samples were obtained after bronchoscopy. MEASUREMENTS AND RESULTS: Biopsy specimens and cell count in the BALF were examined by light microscopy. PMN-Elastase and albumin were measured in the BALF-supernatant and in the plasma. C-reactive protein (CRP) and a1 proteinase inhibitor (a1-PI) were measured in the plasma. Intrapulmonary originating PMN-Elastase was calculated with reference to albumin. The results concerning acute inflammation obtained by transbronchial lung biopsy (TBLB) (n = 16) correlated better with the levels of PMN-Elastase in the BALF (n = 21) than with the neutrophil count (n = 28) (p < 0.5 versus p < 0.025 for chi 2). The sensitivities and specificities of the above methods were respectively 76.9%, 100%, 100% and 100%, 95.2%, 63.1%. The intrapulmonary originating PMN-Elastase was about 99.7% of the measured BALF-Elastase. CONCLUSION: The PMN-Elastase concentration in the BALF is a more accurate indicator of the inflammatory intensity in the alveolar structures than in the number of neutrophils. It may therefore be useful to the clinician in his attempt to detect acute inflammation in the lower respiratory tract.

The systemic effect of cancers on human sera proton NMR relaxation times.

In animal models of cancer, an elevation of T1 and T2 in uninvolved tissues and in the blood of tumor bearing animals has been termed "the systemic effect." This study reports T1 values in sera of human patients from Genoa, Italy, with several types of cancer and non-cancerous diseases. T1 values were significantly elevated over normal controls (1628 +/- 113 ms) in colorectal cancers (1725 +/- 149 ms) and stomach cancers (1817 +/- 219 ms). However a systemic effect was not demonstrated in acute myeloid leukemia, chronic lymphatic leukemia, chronic myeloid leukemia, or plasma cell myeloma, or in pancreatic and lung cancers. Noncancerous states of cirrhosis, chronic hepatitis, and monoclonal gammapathies did not show a T1 elevation. In general, T1 values of sera correlated with protein content of the sera; however, a disproportionate contribution of gamma-globulin protein on water proton relaxation times was observed in several cases.

Bronchoalveolar lavage in the diagnosis of disseminated lung tumors.

We report our experience with bronchoalveolar lavage (BAL) and its value in the diagnosis of malignant lung infiltrates. A total of 162 patients with biopsy- or autopsy-proven cancer had an analysis of BAL fluid performed. Cytologic examination showed malignant cells in 123 (76%) patients. The diagnostic accuracy varied depending on the neoplastic nature and growth pattern of the disease. BAL disclosed cancer cells in 93% of 44 bronchioloalveolar carcinomas. Carcinomatous lymphangitis due to metastatic cancer was diagnosed in 83% of 69 cases. Hematogenous metastases (with sharply circumscribed nodules on chest radiography) were diagnosed in 45% of 22 such cases. We recognized 67% of 15 non-Hodgkin's lymphomas and 3 of 9 cases of Hodgkin's disease with pulmonary involvement. Immunocytochemistry using monoclonal and/or polyclonal antibodies was of value in the identification and classification of cells in non-Hodgkin's lymphoma.

[Evaluation of the diagnostic role of the carcinoembryonic antigen in ascitic fluid]. / Contributo alla valutazione del ruolo diagnostico dell'antigene carcino-embrionario nel liquido ascitico.

The diagnostic role of carcinoembryonic antigen (CEA) in ascitic fluid was evaluated in order to assess whether or not ascitic haemorrhage is related to cancer. A total of 30 patients with ascitic haemorrhage were analysed (17 had cirrhosis, 5 non-metastasised cancers and 8 metastasised cancers). CEA radioimmunoassay was performed in serum and ascitic fluid. The results showed that CEA in the ascitic fluid highlighted a clear distinction between the average values of the 3 groups examined serum assay did not. Results were respectively: cirrhotic patients 6.11, non-metastasised cancers 38 and metastasised cancers 204.12. Ascitic fluid measurement revealed considerable variation, especially between the first and third groups examined (p = .00000004). Although CEA must be regarded as an aspecific laboratory test for malignancy, these results suggest that CEA determination in the ascitic fluid may be useful for screening patients with ascitic haemorrhage.

[Unilateral gynecomastia induced by the use of anabolic steroids. A clinical case report]. / Ginecomastia unilaterale indotta dall'uso di steroidi anabolizzanti. Descrizione di un caso clinico.

The authors studied a case of left unilateral gynecomastia occurring in a 26-year-old body-builder after anabolic steroids assumption. The mammal features were found by echography and mammography and they showed the presence of a 3 cm diameter retroareolar area of gland tissue surrounded by fibrotic tissue. After excluding every likely cause giving gynecomastia through laboratory tests, it was clear a relationship with the assumption of high doses of anabolic hormones, with particular regard to methyltestosterone. Therefore, also this substance which on its own is not aromatized by extrasplanchnic tissues, can be responsible for man's mammal hypertrophy, if joined to a slight iatrogenic liver cytolysis.

[Efficacy of bronchoscopic Nd:YAG laser therapy for laryngotracheal stenoses after long-term intubation]. / Zur Effizienz der bronchoskopischen Nd:YAG-Lasertherapie für laryngotracheale Stenosen nach Langzeitintubation.

From 1987 to 1993, 38 patients with laryngotracheal stenosis due to prolonged intubation were treated with the Nd:YAG-laser. A total of 45 stenoses were identified and classified according to endoscopic assessment. Patients who had an asymptomatic airway for at least 8 months and did not require further intervention were considered treatment successes. The best results were found in the diaphragmas and granulomas (86% and 65%), in stenoses less than 1 cm in length (61%) and in cases with less than 70% obstruction of the tracheal lumen (61%).

[Current potential of fiberscopy in the diagnosis of bronchopulmonary lesions]. / Le attuali possibilita' della fibroscopia nella diagnostica delle affezioni broncopolmonari.

The Authors relate the results of their casuistics of bronchial endoscopies. Out of 3438 endoscopies, 1237 were bronchial biopsies and 496 lung biopsies. According to the results obtained the Authors have concluded that this method represents an important progress in thoracic endoscopy. It can be also widely applied for the diagnosis of bronchopulmonary diseases.

Transbronchial lung biopsy in infiltrative lung disease. The importance of the pathologic approach.

Infiltrative diffuse lung diseases represent a heterogenous group of lesions with overlapping clinical and roentgenological features. Their diagnosis frequently needs a pathologic approach. We report our experience (671 patients with lung infiltrates) with transbronchial lung biopsy (TBB) procedure. The results of morphologic investigation were subdivided into three groups: 1) A specific morphologic diagnosis was made in 192 cases (29%) 2) Histopathologic changes well consistent with the clinical pattern were present in 258 patients (38%) 3) Non-specific lesions were found in 221 cases (33%). The diagnosis yield of the method was of 67%. UIP, DIP, Pulmonary Angiitis and Granulomatosis, Bronchiolitis Obliterans-Organizing Pneumonia and other rarer lung diseases may not be diagnosed on the basis of lesions present in TBB specimens.

Transbronchial lung biopsy and bronchoalveolar lavage in diagnosis of diffuse infiltrative lung diseases.

We investigated 801 patients with lung infiltrates who underwent transbronchial lung biopsy (TBB) and performed cytologic studies of lavage fluid of 491 patients who also underwent bronchoalveolar lavage (BAL). A specific histopathological diagnosis was made in 232 cases (29%). Histopathological changes consistent with the clinical pattern were present in 296 cases (37%). The diagnostic yield of TBB was 66%. Routine evaluation of BAL fluid allowed us to make a specific diagnosis in 49 cases. The role of the pulmonary pathologist in the interpretation of TBB and BAL specimens is discussed.