Evidence Of Pulmonary Fibrosis Research Articles

Bronchoalveolar Lavage Desmosine in Bleomycin-Induced Lung Injury in Marmosets and Patients with Adult Respiratory Distress Syndrome

Measurement of urinary desmosine in experimental models of emphysema has been used to demonstrate elastin catabolism. In order to evaluate the hypothesis that accelerated elastin degradation also occurs in association with acute lung injury characterized by fibrotic repair, we prepared acid hydrolysates of lung lavage (LL) and used a radioimmunoassay for desmosine to measure concentrations of this elastic-specific cross-link in LL. Lavage desmosine (pmol/100 microliter LL) was measured following bleomycin-induced lung injury in marmosets and was shown to be elevated at 1 week (median 6.0, range 5.1-7.8), 2 weeks (8.4, 6.2-8.7), and 4 weeks (7.6, 4.8-7.8) compared to control levels (1.8, 1.4-3.7). Elevations of lavage desmosine after bleomycin were temporarily associated with remodeling of the lung as indicated by increased total lung collagen, reduced diffusing capacity and lung compliance, and histologic evidence of pulmonary fibrosis. Bronchoalveolar lavage (BAL) desmosine was measured in patients with the Adult Respiratory Distress Syndrome (ARDS) and compared with patients at risk, patients with other interstitial lung diseases, and normal healthy controls. BAL desmosine (pmol/100 microliters) was not significantly different in patients with ARDS (3.2, 2.1-3.0), patients at risk for ARDS (2.8, 2.5-4.4), and those with interstitial lung disease (3.0, 1.7-5.3) compared to normal controls (2.9, 1.9-4.7). There were poor correlations of BAL desmosine with physiologic indices of severity of disease in patients with ARDS and those at risk. Accelerated elastolysis occurred in the lower respiratory tract during the evaluation of bleomycin-induced pulmonary fibrosis in marmosets but was undetectable in BAL of patients studied within the first 3 days of ARDS.

Preliminary Results of the GPO-Trial for Treatment of Non-Testicular Germ-Cell Tumors in Children and Adolescents

Germ cell tumors account for a 3% mortality rate of childhood malignancies. The combined chemotherapy, vinblastine, bleomycin and cis-platinum, is probably associated with more toxicity and treatment-induced mortality in children. Based on pharmacokinetic findings concerning the renal elimination of bleomycin and the well known cis-platinum nephrotoxicity, these two drugs were given sequentially. In addition, the cumulative dose of bleomycin was limited to 180 mg/m2. 61 patients entered the trial whereby 42 of these are evaluable. The chemotherapeutic regimen was well tolerated and was completed in 19 patients without treatment induced mortality and without evidence of pulmonary fibrosis. The treatment regimen seems to be successful despite the relatively low cumulative doses of vinblastine and bleomycin, as only 4 of 19 patients relapsed after a median observation period of 12 months.

Pulmonary function of exposed and control workers in a Nigerian nonsoapy detergent factory.

Respiratory symptoms and spirometric pulmonary function data [i.e., first-second forced expiratory volume (FEV1.0) and forced vital capacity (FVC)] for 128 (30%) males who were exposed to alkyl benzene sulphonate in a detergent factory and for 56 (76%) unexposed workers in the same factory are reported herein. Exposed subjects had been employed for 1 month to 15 yr, and they generally complained of cough and mucus secretions, nasal catarrh, chest pain, and breathlessness. Unexposed workers had been employed for 1 month to 13 yr and had a significantly lower (P less than .001) frequency of symptoms, as well as significantly higher (.01 greater than P greater than .001) FEV1.0 and FVC than the exposed workers. The reduction in pulmonary function of exposed subjects from the predicted was significantly higher (.01 greater than P greater than .001) than that experienced by the unexposed subjects. There was a significant 8-hr workshift depression in lung function. There was radiological evidence of pulmonary fibrosis, but lack of pre-employment chest radiographs renders this inconclusive. Respiratory symptoms in exposed subjects decreased with duration of employment, which probably indicates the exodus from the work force of those who could not tolerate the nonsoapy detergent.

Ventilatory function and transfer factor in ankylosing spondylitis.

Thirty-eight patients with ankylosing spondylitis, with a wide range of disease severity and duration were studied for evidence of parenchymal lung disease. Significant restriction of ventilatory excursion and reduction of lung volume was confirmed. The transfer factor was normal. In no case was there radiological or functional evidence of pulmonary fibrosis, even in those with extensive long standing spinal disease.

The Lipoid Pneumonia of Blackfat Tobacco Smokers in Guyana

In Guyana, a large number of patients have been diagnosed as having a diffuse pulmonary fibrosis of unknown aetiology, characterized by typical radiological appearances, dyspnoea, cough, weight loss, and eventually pulmonary heart disease. Investigation of 56 patients showed that all had smoked a tobacco known as ‘blackfat’ or ‘black tobacco’. In a community survey 20·4 per cent of the population aged 55 years and over smoked this tobacco. 19·6 per cent of the blackfat smokers but no non-blackfat smokers showed definite radiological evidence of pulmonary fibrosis. Smokers with, but not those without fibrosis, had severe airways obstruction. Immunological studies made it unlikely that an extrinsic allergic alveolitis had caused the radiological changes. Three post-mortem open-lung specimens were obtained and in each case the histology showed a diffuse interstitial fibrosis and vasculitis associated with large deposits of lipid surrounded by black amorphous material. Blackfat is a tobacco leaf to which mineral oil and vaseline are added for flavouring and as humectants. The presence of oil in the tobacco, and the post-mortem findings of oil in the lungs, indicate that the diffuse pulmonary fibrosis can be more accurately described as a lipoid pneumonia caused by the inhalation of mineral oils when blackfat is smoked. The potential health hazards of many tobacco additives, particularly oils, employed by the tobacco industry should be recognized. A similar type of disease as that found in Guyana may be present in other parts of the world where blackfat, or related tobaccos, are smoked.

Incidence of radiation fibrosis after use of a standardized technique of radiotherapy for breast cancer.

To determine whether the use of a standardized technique of radiotherapy for breast cancer was followed by roentgenographic evidence of pulmonary fibrosis, a survey was made of the serial chest roentgenograms of 42 patients with breast cancer who had received such radiotherapy 2 1/2 years previously. Also reviewed, to aid in identification of roentgenographic changes caused by other disease, were their clinical notes, hospital records and, in 5 instances, autopsy protocols. Evidence of slight pulmonary fibrosis appeared on the chest roentgenograms of 6 patients as one or more fibrotic strands, 2 or 3 cm long, in the lung underlying x-irradiated regions of the thoracic wall. The affected lungs were not retracted or distorted. Evidence of radiation fibrosis did not appear on the serial chest roentgenograms of the other 36 patients. Among these 42 disparate patients with breast cancer observed for at least 2 1/2 years this standardized technique of radiotherapy did not cause roentgenographic evidence of significant pulmonary fibrosis.

Lung Volume and Pulmonary Dynamics in Raynaud's Disease. Effect of Exposure to Cold

The occurrence of diffuse pulmonary fibrosis in patients with Raynaud's disease and scleroderma, though rare, has been noted in several instances.1, 2 The question, therefore, arises as to whether the lung volume and pulmonary dynamics are abnormal in patients with Raynaud's disease and, more particularly, whether exposure to cold affects their pulmonary function. Three patients have been studied; all were females and ranged in age from 15 to 39 years. One of them (Case 3) had cough, dyspnea and X-ray evidence of diffuse pulmonary fibrosis of the type associated with Raynaud's disease.2 No such findings were present in the other two. All studies were made by the method of Christie,3 with the patients in the recumbent position. Measurements were made before and again after the patients' legs and at least one hand had been exposed to ice.Observations. The lung volume and pulmonary dynamics in the 2 patients (Cases 1 and 2) with no clinical or X-ray evidence of pulmonary fibrosis were within normal limits. C...