Damage To Respiratory Tract Research Articles

Acute effects of sulfur mustard injury—Munich experiences

Sulfur mustard (SM) is a strong vesicant agent which has been used in several military conflicts. Large stockpiles still exist to the present day. SM is believed to be a major threat to civilian populations because of the persistent asymmetric threat by non-state actors, such as terrorist groups, its easy synthesis and handling and the risk of theft from stockpiles. Following an asymptomatic interval of several hours, acute SM exposure produces subepidermal skin blisters, respiratory tract damage, eye lesions and bone marrow depression. Iranian victims of SM exposure during the Iran–Iraq (1984–1988) war were treated at intensive care units of 3 Munich hospitals. All 12 patients were injured following aerial attacks with SM filled bombs, which exploded in a distance between 5 and 30 m. All patients soon noted an offensive smell of garlic, addle eggs or oil roasted vegetables. No individual protective equipment was used. Eye itching and skin blistering started 2 h after SM exposure. Some patients complained of nausea, dizziness and hoarseness. 4 h after exposure, most patients started vomiting. Eye symptoms worsened and most patients suffered from temporary blindness due to blepharospasm and lid oedema. Additionally, pulmonary symptoms such as productive cough occurred. Patients were transferred to Munich 4–17 days after SM exposure. On admission all patients showed significant skin blistering and pigmentation. Conjunctivitis and photophobia were the major eye symptoms. Pulmonary symptoms, including productive cough were persistent. Bronchoscopy revealed massive inflammation of the trachea with signs of necrosis. 3 patients needed tracheotomy. Chest X-ray did not yield abnormal observations. This presentation summarizes the experience of treating SM victims in Munich and discusses therapeutic implications.

Avian pathogenic Escherichia coli bind fibronectin and laminin

Avian colisepticemia frequently occurs after respiratory tract damage, the primary site for infection allows bacteria to encounter an exposed basement membrane, where laminin and fibronectin are important components. We investigated the ability of an isolate of avian pathogenic Escherichia coli to bind fibronectin and laminin. Using Far-western dot blot analysis, we demonstrated the ability of this microorganism to bind basement membrane proteins fibronectin and laminin. Results from an ELISA-based approach indicate that the binding to these membrane proteins was bacterial-dose dependent. Furthermore, two specific E. coli polypeptides, of 32 kDa and 130 kDa, reacted with laminin and fibronectin, respectively. Further evaluation of these potential bacterial adhesins may provide insights into the pathogenesis of colibacillosis.

Severe acute respiratory syndrome vaccine efficacy in ferrets: whole killed virus and adenovirus-vectored vaccines

Although the 2003 severe acute respiratory syndrome (SARS) outbreak was controlled, repeated transmission of SARS coronavirus (CoV) over several years makes the development of a SARS vaccine desirable. We performed a comparative evaluation of two SARS vaccines for their ability to protect against live SARS-CoV intranasal challenge in ferrets. Both the whole killed SARS-CoV vaccine (with and without alum) and adenovirus-based vectors encoding the nucleocapsid (N) and spike (S) protein induced neutralizing antibody responses and reduced viral replication and shedding in the upper respiratory tract and progression of virus to the lower respiratory tract. The vaccines also diminished haemorrhage in the thymus and reduced the severity and extent of pneumonia and damage to lung epithelium. However, despite high neutralizing antibody titres, protection was incomplete for all vaccine preparations and administration routes. Our data suggest that a combination of vaccine strategies may be required for effective protection from this pathogen. The ferret may be a good model for SARS-CoV infection because it is the only model that replicates the fever seen in human patients, as well as replicating other SARS disease features including infection by the respiratory route, clinical signs, viral replication in upper and lower respiratory tract and lung damage.

Fibreoptic bronchoscopy in routine clinical practice in confirming the diagnosis and treatment of inhalation burns

Fibreoptic bronchoscopy has been recently introduced to our practice, its value in the diagnosis and management of respiratory tract burns has been well established. The aim of the prospective study was to ascertain whether, in our routine clinical practice, a correlation could be shown between clinical and bronchoscopic diagnosis. The outcome of the study could support a rationale for introduction of this tool in other centers in Poland. In the period between 1 October 2001 and 30 June 2004, of the1247 burn patients, that were hospitalized in our centre and admitted directly after burn, N = 292 patients (59 women and 233 men) were included in the study. For clinical diagnosis, a clinical pathway was used, which includes a questionnaire probing for signs and symptoms of inhalation trauma. When on initial assessment there was a suspicion of inhalation trauma (>3/11 points), a prompt fibreoptic bronchoscopy was performed. Diagnoses of an inhalation burn was confirmed in 261/292 patients, of whom upon initial assessment an inhalation trauma was suspected. Clinical assessment showed that 62/261 scored 5/11, 57/261 scored 6/11, 122/261 had a score of 7/11 and 20/261 scored >7/11. In this group an upper respiratory tract burn was diagnosed in 111/261 cases, damage of the main respiratory tract in 130/261 cases, and an inhalation trauma of the lower respiratory tract was confirmed in 20/261 cases. Based on our findings we concluded that fibreoptic bronchoscopy was shown to be a useful method in our routine clinical practice to confirm diagnosis and treatment of inhalation burns. The high agreement between the clinical suspicion of inhalation injury and the incidence confirmed by bronchoscopy and biopsies, suggest that the clinical indicators we use are reliable. We noted that performing fibreoptic bronchoscopy in patients with acute breathing insufficiency, who are intubated and require high concentrations of oxygen, is not recommended.

Comparing the efficiency of chitosan with chlorine for reducing Vibrio parahaemolyticus in shrimp

Thailand is one of the leading exporters of frozen shrimp to many countries. Chlorine is the decontaminating agent most frequently used in the frozen shrimp industries to kill potential pathogens. However, long time contact to chlorine causes severe respiratory tract damage. In this study, chitosan was compared to chlorine for reducing Vibrio parahaemolyticus. In vitro investigation, chitosan could reduce more than 90% of V. parahaemolyticus, whereas chlorine completely eliminated this organism. In artificially inoculated shrimp, more than 90% reduction of V. parahaemolyticus was achieved by chitosan. A similar reduction was obtained by chlorine, however, at lower concentrations and less contact time. In naturally contaminated shrimp, neither agent completely eradicated V. parahaemolyticus, however, chitosan achieved a decrease of more than 60%. These results demonstrate the possibility of using chitosan to decontaminate pathogenic bacteria in the seafood factory, a change that would diminish health problems of the workers.

Influenza virus receptors in the human air way

Avian influenza A (H5N1) virus infections have resulted in more than 100 human deaths; yet, human-to-human transmission is rare. We demonstrated that the epithelial cells in the upper respiratory tract of humans mainly possess sialic acid linked to galactose by alpha 2,6 linkages (SA alpha 2,6Gal), a molecule preferentially recognized by human viruses. However, many cells in the respiratory bronchioles and alveoli possess SA alpha 2,3Gal, which is preferentially recognized by avian viruses. These facts are consistent with the observation that H5N1 viruses can be directly transmitted from birds to humans and cause serious lower respiratory tract damage in humans. Furthermore, this anatomical difference in receptor prevalence may explain why the spread of H5N1 viruses among humans is limited. However, since some H5N1 viruses isolated from humans recognize human virus receptors, additional changes must be required for these viruses to acquire the ability for efficient human-to-human transmission.

Drug Abuse: Meth’s Pollution Epidemic

Methamphetamine problems are soaring nationwide. Nearly 60% of county officials report that meth is the largest drug problem in their county, and 87% saw jumps in meth arrests in the past three years, according to a survey released in July 2005 by the National Association of Counties. But meth isn’t just a hard drug; it’s also an environmental hazard. Illicit drug makers can cook small batches of meth anywhere they can plug in a stove, microwave, or electric skillet (heat is not required, but speeds the manufacture). The ingredients include common cold medicines, ammonia fertilizer, and muriatic acid. Cooking generates a variety of noxious solvents and gases, such as hydrogen chloride, phosphine, and meth itself. According to an 8 August 2005 Newsweek article, for each pound of meth produced, five pounds of toxic waste are left behind. Police and firemen report breathing problems and headaches when they bust meth labs, but no one has quantified the hazards they face. So John Martyny, an industrial hygienist at National Jewish Medical and Research Center in Denver, teamed up with law enforcement officials in Colorado. They set up controlled cooks in an abandoned motel (which was later razed) and measured the resulting pollutants. In the unpublished studies, phosphine gas reached 2.9 parts per million (ppm), three times the occupational short-term exposure limit. Phosphine causes headache, pulmonary edema, and death. Martyny says cook fatalities are probably linked to this chemical. Hydrogen chloride fumes reached 155 ppm, more than three times the level considered by the National Institute for Occupational Safety and Health to be “immediately dangerous to life or health.” Hydrogen chloride causes respiratory tract damage. Ammonia, which causes lung edema, also soared to three times the “immediately dangerous to life or health” level. Anyone who is present during cooks is exposed to these and likely other toxicants; a third of all meth busts find children present. “The health costs to children may not be identified for years to come,” says Martyny, who predicts long-term respiratory and neurological problems. More research is needed to determine the best ways to clean up meth labs. Meth becomes airborne during production and settles on surfaces at up to 16,000 micrograms per 100 square centimeters (μg/100 cm2). Even six months after a staged cook, Martyny found meth levels of 300 μg/100 cm2 on surfaces. Carpets trap meth and other pollutants, yet vacuuming dra-meth levels. So Martyny recommends discarding carpets. Further, after grinding contaminated wallboard in separate unpublished studies, Stephen Lee, who supervises the Emergency Response Team at the Minnesota Pollution Control Agency in St. Paul, learned that washing walls removes less than 10% of the total meth. The rest is trapped deeper. Whether it bleeds back out to the surface and poses an exposure risk is unknown. Lee is evaluating whether a covering of oil-based paint seals meth within wallboard. Few states have guidelines for cleaning up meth labs. “As more states deal with remediation of meth properties, they turn to us,” says Carolyn Comeau, manager of the Clandestine Drug Lab Program at the Washington State Department of Health. Washington requires remediation by contractors certified by the state to decontaminate meth labs, which are often found in low-income rental properties. The state also requires that surface meth be at or below 0.1 μg/100 cm2 before new residents can move in. Scientific evidence like Martyny’s and Lee’s should yield more effective guidelines, says Comeau. Lee adds that a health-based standard for meth residues on building surfaces is needed to determine which properties need remediation and when a property has been adequately cleaned. All three experts support national remediation standards like those proposed in the Methamphetamine Remediation Research Act of 2005, which would establish a federal research program at the Environmental Protection Agency to study the environmental and health effects of meth labs and coordinate cleanup efforts. The bill has 55 cosponsors, and floor passage in the House is expected later this year.

Medical aspects of sulphur mustard poisoning

Sulphur mustard is one of the major chemical warfare agents developed and used during World War I. Large stockpiles are still present in several countries. It is relatively easy to produce and might be used as a terroristic weapon. Sulphur mustard is a vesicant agent and causes cutaneous blisters, respiratory tract damage, eye lesions and bone marrow depression. The clinical picture of poisoning is well known from the thousands of victims during World War I and the Iran–Iraq war. In the latter conflict, sulphur mustard was heavily used and until now about 30,000 victims still suffer from late effects of the agent like chronic obstructive lung disease, lung fibrosis, recurrent corneal ulcer disease, chronic conjunctivitis, abnormal pigmentation of the skin, and several forms of cancer. Despite enormous research efforts during the last 90 years, no specific sulphur mustard antidote has been found. The prospering knowledge and developments of modern medicine created nowadays new chances to minimize sulphur mustard-induced organ damage and late effects.

Motorcycle exhaust particles induce airway inflammation and airway hyperresponsiveness in BALB/C mice.

A number of large studies have reported that environmental pollutants from fossil fuel combustion can cause deleterious effects to the immune system, resulting in an allergic reaction leading to respiratory tract damage. In this study, we investigated the effect of motorcycle exhaust particles (MEP), a major pollutant in the Taiwan urban area, on airway inflammation and airway hyperresponsiveness in laboratory animals. BALB/c mice were instilled intratracheally (i.t.) with 1.2 mg/kg and 12 mg/kg of MEP, which was collected from two-stroke motorcycle engines. The mice were exposed 3 times i.t. with MEP, and various parameters for airway inflammation and hyperresponsiveness were sequentially analyzed. We found that MEP would induce airway and pulmonary inflammation characterized by infiltration of eosinophils, neutrophils, lymphocytes, and macrophages in bronchoalveolar lavage fluid (BALF) and inflammatory cell infiltration in lung. In addition, MEP treatment enhanced BALF interleukin-4 (IL-4), IL-5, and interferon-gamma (IFN-gamma) cytokine levels and serum IgE production. Bronchial response measured by unrestrained plethysmography with methacholine challenge showed that MEP treatment induced airway hyperresponsiveness (AHR) in BALB/c mice. The chemical components in MEP were further fractionated with organic solvents, and we found that the benzene-extracted fraction exerts a similar biological effect as seen with MEP, including airway inflammation, increased BALF IL-4, serum IgE production, and induction of AHR. In conclusion, we present evidence showing that the filter-trapped particles emitted from the unleaded-gasoline-fueled two-stroke motorcycle engine may induce proinflammatory and proallergic response profiles in the absence of exposure to allergen.

A new technique for foetal brain fixation and extraction

We performed a new technique for foetal brain fixation and extraction that offers a remarkable reduction in sampling time facilitates specimen handling while conserving high quality. With the new fixation method, it is possible to obtain samples adequate for macroscopic and microscopic observations and immunohistochemical analysis. The technique involves the creation of an ex vacuo phenomenon in the subarachnoideal space prior to injecting the fixative solution. In this manner, the solution is homogenously distributed. Ease, reproducibility and the possibility of standardizing the procedure are the principal advantages. Low costs, reduced wording time and less need for human resources are other advantages. Histologically, we obtained, quickly, high quality slides with routine and immunohistochemical stains. Disadvantages of the technique derive from the use of formaldehyde and glacial acetic acid, rather than water to wash the samples; thus one must work in a well ventilated area, with gloves, protective glasses and an adequate lab coat to avoid skin and respiratory tract damage.

Respiratory tract pathology and cytokine imbalance in clinically healthy children chronically and sequentially exposed to air pollutants

Chronic exposure of children to a complex mixture of air pollutants leads to recurrent episodes of upper and lower respiratory tract injury. An altered nasal mucociliary apparatus leaves the distal acinar airways more vulnerable to reactive gases and particulate matter. The heterogeneity of structure in the human lung can impart significant variability in the distribution of ozone dose and particle deposition; this, in turn, influences the extent of epithelial injury and repair in chronically exposed children. Cytokines are low-molecular-weight proteins that act as intercellular mediators in inflammatory reactions, including lung injury of various etiologies. Cytokines are involved in generating inflammatory responses that contribute to injury at the lung epithelial and endothelial barriers.Mexico City is a 20-million-person megacity with severe air pollution problems. Southwest Metropolitan Mexico City (SWMMC) atmosphere is characterized by a complex mixture of air pollutants, including ozone, particulate matter (PM), and aldehydes. There is radiological evidence that significant lower respiratory tract damage is taking place in clinically healthy children chronically and sequentially exposed to air pollutants while growing up in SWMMC.We hypothesize that there is an imbalanced and dysregulated cytokine network in SWMMC children with overproduction of proinflammatory cytokines and cytokines involved in lung tissue repair and fibrosis. The nature of the sustained imbalance among the different cytokines ultimately determines the final lung histopathology, which would include subchronic inflammation, emphysema, and fibrosis. Cytokines likely reach the systemic circulation and produce systemic effects. Individuals with an underlying respiratory or cardiovascular disease are less able to maintain equilibrium of the precarious cytokine networks. 2000 Harcourt Publishers Ltd

Cough frequency and cough-receptor sensitivity are increased in man at altitude.

1. Travellers to high altitude often complain of paroxysmal cough, which has not been previously investigated. We recorded overnight cough frequency and cough-receptor sensitivity to inhaled citric acid in a group of climbers travelling to 5300 m or higher. 2. Cough frequency, monitored in ten subjects, increased from a median of 0 coughs at sea level (range 0-1) to 5 coughs at 5000 m (range 0-13) and to over 60 coughs in subjects ascending to 7000 m. Citric acid cough threshold, measured in 42 subjects, was unchanged on arrival at 5300 m compared with sea level (geometric mean difference 1.26, 95% confidence intervals 0.84-1.89, P = 0.25), but was significantly reduced after 6 days, or more, at altitude compared with sea level (geometric mean difference 2.2, 95% confidence intervals 1.54-3.15, P = 0.0002). Cough threshold was not related to symptoms of acute mountain sickness, oxygen saturation, carbon dioxide tension or lung function. 3. These results indicate an increase in cough and cough-receptor sensitivity after some days at altitude. This may be due to respiratory tract damage from breathing cold dry air at increased ventilatory rates. Other explanations, such as sub-clinical pulmonary oedema or an effect on the cough centre of acclimatization to altitude, cannot be excluded.

Management of airway problems in severely burned patients.

Coincident with significant improvement in the management of shock, fluid management and sepsis in the severely burned patients, respiratory tract damage has emerged as the principal killer in burned patients. Despite the recognized nature of this aspect of the severely burned patient, and despite extensive clinical studies and laboratory research, there remains considerable confusion and disagreement regarding the assessment and management of burned patients with respiratory tract damage. Very frequently, the otolaryngologist may be called upon to provide the necessary measures in the management of these patients, especially regarding tracheostomy and problems of tracheobronchial toilet.

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Oropharyngeal fluorography is a simple method with high reliability for checking the degree, cause and locus of dysphagia, because we can observe every part of the process of swallowing. This examination is also useful to detect the organic or functional dysfunction of the oral cavity, pharynx, and esophagus.This paper will describe oropharyngeal fluorography for the image diagnosis of dysphagia.Deglutition time is too short to evaluate all of the processes of swallowing precisely in a single moment. Examinations do not always reflect usual deglutition conditions because the contrast media used in examinations are different from usual diet contents.We should pay attention especially to the following in examining the patient who has aspiration.1. We have to select contrast media carefully, because lower respiratory tract damage occurs using inappropriate media such as Barium or high osmotic substance.2. We should only do a few trials of swallowing in patients having severe aspiration that might cause respiratory damage.3. It is difficult to take a X-ray photo in proper timing with deglutition especially in functional dysphagia.Recording on video tape is preferable for this type of examination, especially in cases having aspiration or some disorder. We could analyze the details of organic or functional disorders with this system by playing back in slow motion many times.There are limits in evaluating the swallowing function using only oropharyngeal fluorography. It is possible that a more correct evaluation of the swallowing function will be produced in combination with electro-myogram and intrapharyngeal manometry.

Nasal and pulmonary toxicity of glutaraldehyde in mice

A concentration-dependent expiratory bradypnea, indicative of sensory irritation, occurred during a 15-min oronasal exposure of mice to glutaraldehyde in the concentration range of 0.7–4.5 ppm. The level of exposure which led to a 50% decrease in the respiratory rate (RD 50) was found to be 2.6 ppm. For assessment of nasal toxicity, mice were exposed to glutaraldehyde vapours with concentrations of 2.6, 1.0, 0.3 ppm for periods of 6 h/day over the course of 4,9 and 14 days and were immediately killed. Recovery was studied with another group of mice exposed to 1.0 ppm for 14 days and sacrificed after 1, 2 and 4 weeks rest time. Control groups were concurrently exposed to clean filtered air. The earliest lesions were observed in the respiratory epithelium of the septum, the naso- and maxilloturbinates, after 4 days of exposure to 0.3 ppm. Severe histopathological changes were still observed 2 weeks after the end of the exposure to 1.0 ppm. No exposure-related histological abnormalities were detected in the trachea and lungs. In conclusion, this experiment demonstrates that repeated exposure to 1 10 RD 50 is associated with upper respiratory tract damage in mice, and this value does not seem to be an acceptable concentration limit for occupational exposure.

急性間質性肺炎の1剖検例

An autopsy case of a 77-year-old male with acute interstitial pneumonia (AIP) is reported. The patient died of respiratory failure in the extremely rapid course of 8 days. The histogenesis of the thickening of the alveolar wall and the intraluminal lesions were noticed. Incorporation of the hyaline membrane as well as the intraseptal edema and septal cell proliferation played an important role in the fibrous thickening of the alveolar wall. The intraluminal granulation tissue was observed in the alveolar space and the alveolar duct, often extending into the respiratory bronchioles. Intraluminal granulation tissues in the alveoli frequently had the appearance of intraluminal buds of mesenchymal cells, so-called Masson's bodies, and there was little remodeling of pulmonary structures in this case. These findings suggest an acute, diffuse and severe damage of the peripheral respiratory tract and are consistent with bronchiolitis obliterans with classical interstitial pneumonia (BIP) by Liebow and AIP by Katzenstein. This patient had suffered from suspected "Bronchiolitis obliterans organizing pneumonia" (BOOP) one and half years ago. The relationship between AIP, BIP and BOOP is discussed.

Preservation of humidity and heat of respiratory gases during anaesthesia--a laboratory investigation.

Humidification and heating of anaesthetic gases are desirable to prevent respiratory tract damage and a fall in body temperature during operative procedures. Numerous studies on the humidity and temperature of inspiratory gases in different breathing systems for anaesthesia have been carried out, but comparisons are difficult since different methods have been used. In this laboratory set-up we studied a non-rebreathing system with and without humidifiers and a circle absorber system with low (0.5 l/min) or medium (5 l/min) fresh gas flows regarding their ability to heat and humidify anaesthetic gases. The humidity of inspired gases was acceptable in the non-rebreathing system using either a Bennett Cascade humidifier or disposable humidifiers and in the circle absorber system using a fresh gas flow of 5 l/min or less. The temperature of the inspired gases was highest with the Bennett Cascade humidifier, followed by the low-flow circle system. The circle absorber system used with low fresh gas flow gave higher inspiratory gas temperature and humidity than the non-rebreathing system with a good disposable humidifier.

Respiratory Care of the Burn Patient

The vast majority of respiratory disorders in thermally injured patients arise from associated inhalation injuries. The major forms of these injuries are carbon monoxide poisoning, injury to the upper airway, and pulmonary parenchymal damage. One hundred per cent oxygen, initiated at the scene of the accident, is the single most effective treatment of carbon monoxide toxicity, which must be assessed by carboxyhemoglobin determinations. Respiratory tract damage is identified by fiberoptic bronchoscopy and xenon ventilation-perfusion scintigrams. The compromised airway is protected by tracheal intubation, and respiratory failure is treated with assisted ventilation and supplemental oxygen. Pulmonary infection requires specific antibiotics based on isolated organisms and their sensitivities to antimicrobials. The upper respiratory tract of patients requiring long-term intubation should be assessed by fiberoptic bronchoscopy and other modalities to prevent fatal late airway occlusion.

Influence of dietary vitamin E on susceptibility to ozone exposure.

It is widely reported that vitamin E intake may markedly reduce the occurrence of ozone-induced respiratory tract damage. Considerably less data are available concerning whether vitamin E nutritional status may affect the occurrence of ozone-induced systemic alterations such as the blood cell changes. The present study is designed to extend this previous research by evaluating the extent to which vitamin E supplementation in humans over a four week period would affect the in vitro erythrocyte susceptibility to hydrogen peroxide (H/sub 2/O/sub 2/) which is formed in whole blood following ozone exposure.

Respiratory tract injury in burning accidents

Seven cases of respiratory tract damage after thermal injury are reported. The aetiology, diagnosis and management of respiratory tract involvement are discussed, and particular importance is given to the need for a high level of suspicion in certain categories of burns, careful and frequent assessment of the state of upper and lower airways, and careful selection of the most appropriate method of respiratory humidification of the inspired air.