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We report the results of a morphological analysis of 60 pulmonary biopsies gathered from a multi center study, organised by the clinico-pathological research group on Wegener's Disease under the auspices of the French Language Society of Thoracic Medicine. Forty of the sixty cases analysed were retained after indexing the histological aspects in order to specify their diagnostic value. Two groups of lesions were distinguished, which had different significance. Group A: These include the three major diagnostic criteria, which reinforce one another as they associate: 1) The polymorphoneutrophil microabscesses with limited central necrosis or an extended necrosis like the contours of a relief map. 2) An angiitis (arteries, veins, capillaries) with eccentric focal parietal crescent-shaped microabscesses. 3) Polymorphous granulomas with giant cells. Group B: In this group are the minor morphological observations (table II) of a lesser value and significance. 1) Acute or chronic lesions with alveolar haemorrhage, endogenous lipid pneumonia, xanthomatous granulomas, an organising pneumonia with an alveolitis. 2) Bronchial lesions: Bronchitis and necrotising bronchiolitis, which is more rarely follicular. 3) Sero-fibrinous or infiltrative neutrophil pleural lesions with focal microabscesses, elastolysis and elastophagia with giant cells in the elastic lamina. Thirteen cases presented with misleading lesions, which was a possible source of diagnostic error and led to a discussion of several associated disorders (Goodpasture's syndrome, and collagen disorder syndrome) or there may be systemic angiitis (Giant cell or lymphocytic) or also systemic or tissue eosinophilia (Churg-Strauss syndrome, bronchocentric granulomatosis) or necrotising bronchitis (atrophic polychondritis) or other forms of nodular interstitial fibrosis, such as histiocytosis X. We would like to stress the great polymorphic variation of the lesions and the difficulties which confront pathologists in the diagnosis of Wegener's Disease, above all when it is localised to the lung. There is value in finding at least one major diagnostic criteria which is associated with a minor criteria and with the help of the C.ANCA levels may lead to a narrow clinicopathological correlation and allows for a fairly precise approach to the diagnosis and identification of early or unusual lesions and thus to the early treatment of patients before irreversible renal failure appears.
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PMID:[Pulmonary lesions in Wegener's disease. Report of the French Anatomo-clinical Research Group. Study of 40 pulmonary biopsies]. 150 87

A health survey was carried out among 8259 second- and fifth-grade schoolchildren living in three towns along the Israeli coast. The schoolchildren performed the following pulmonary function tests: forced vital capacity, forced expiratory volume in 1 sec, and peak expiratory flow, their parents filled out an American Thoracic Society-National Heart and Lung Institute health questionnaire. The aim of the survey was to study the impact of environmental and home exposures on the prevalence of respiratory conditions and on pulmonary function tests among Israeli schoolchildren. The health effects of exposure to passive smoking are discussed in detail. A trend of a higher frequency of reported respiratory conditions was found among schoolchildren whose fathers or mothers are smokers compared with children whose parents do not smoke. A statistically significant excess between 1.4% (for wheezing without cold) and 4.7% (for cough with cold) was found for children of smoking fathers; the excess for children of smoking mothers was between 1.6% (for wheezing with cold) and 3.6% (for cough with cold) compared with children of nonsmokers. A gradual excess in symptoms was found among children with none, one, and two smoking parents. Relative risks were found to be between 1.13 (for bronchitis) and 1.28 (for wheezing without cold) for children of smoking fathers, and between 1.24 (for asthma) and 1.41 (for cough with sputum) for children of smoking mothers, compared with 1.00 for children of nonsmokers. There was no consistent trend of reduced pulmonary function tests among children of smokers compared with nonsmokers' children.
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PMID:Passive smoking among schoolchildren in Israel. 182 Feb 66

Eighteen dogs with chronic bronchitis were studied using physiologic, radiologic, microbiologic, and pathologic techniques. Twelve of these dogs were evaluated before and after two weeks of oral bronchodilator administration. Thoracic radiographs, tidal breathing flow-volume loops, radioaerosol ventilation scans, airway appearance at bronchoscopy, and airway pathology were abnormal in the majority of dogs studied. There was a significant relationship between abnormal ventilation scans and abnormal results for PaO2 and end-tidal airflow. Bronchoscopy revealed excessive mucus and inflammation of airway mucosa in all 16 dogs undergoing this procedure. Endoscopically obtained aerobic bacterial cultures grew mixed bacterial flora in only three dogs. Increased numbers of neutrophils in 14 dogs were detected by airway lavage cytology. A large number of eosinophils were seen in airway lavages obtained from two dogs; these two dogs also had evidence for eosinophilic bronchitis on endobronchial biopsy. Oral bronchodilator administration resulted in clinical and expiratory airflow improvements in most dogs, but had no effect on PaO2 or on the radioaerosol-scan abnormalities. The presence of both the physiologic and pathologic airway abnormalities of chronic bronchitis in dogs presented to a veterinary hospital with chronic unexplained cough was confirmed, suggesting that aerobic bacteria do not play an etiologic role in most cases.
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PMID:Canine chronic bronchitis. A pathophysiologic evaluation of 18 cases. 211 81

A total of 1,566 children the area of Valencia (Spain), of both sexes and aged 7 to 14 received an epidemiological questionnaire recommended by the American Thoracic Society. Antecedents of asthma were recorded in 79 cases (5%), with a predominance among males; 73.3% of these children presented their first crisis before age three. Eighty-seven children were habitual smokers (5.6%), again with a predominance among males-most of these children being between 13 and 14 years old. A family history of smoking was observed in 82.8% of the children who were habitual smokers. A greater predominance of smoking mothers was observed at higher socio-economical levels--with no significant differences between parents. The incidence of respiratory pathology (cough and antecedents of bronchitis) was higher among children whose mothers (or both parents) were smokers. On comparing the two areas of the city with the greatest difference in air pollution level, no significant differences were observed in respiratory morbidity among the child population.
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PMID:[Epidemiologic study of risk factors associated with the development of respiratory pathology in children]. 220 36

The effects on ventilation of the non-selective beta-blocker propranolol, and the relatively cardioselective beta-blocker, metoprolol, were compared in a randomized single-blind crossover study in 16 patients with asthma, bronchitis and emphysema (American Thoracic Society criteria). Group I had "fixed" airways disease with less than 20% improvement in FEV1 following inhaled salbutamol 5 mg by nebuliser. Group II had "reversible" obstruction, greater than 20% improvement. Bronchodilator therapy was withheld for 24 h with the exception of aerosols which were permitted until 12 h before study. After control observations on each of 2 study days, each patient received cumulative doses of propranolol (maximum 170 mg) and metoprolol (maximum 187.5 mg). Ventilatory function (FEV1, FVC, FEV1%) was assessed at 0, 2, 4, 6 and 8 h. In Group I, 2 patients were unable to complete the study. One patient became dizzy with propranolol 70 mg but tolerated metoprolol 187.5 mg. One patient developed wheeze with propranolol 15 mg but tolerated metoprolol 187.5 mg. Metoprolol was tolerated in all 8 patients with "fixed" disease, although FEV1 was reduced by more than 30% in 1 patient. Three patients in Group II did not complete the study because of wheezing following propranolol 10 mg, metoprolol 37.5 mg; propranolol 17.5 mg, metoprolol 37.5 mg; propranolol 45 mg, tolerated metoprolol 187.5 mg respectively. Wheezing responded in all cases to inhaled isoprenaline. The response to either propranolol or metoprolol was unpredictable in patients with "reversible" disease. When wheezing occurred in this group, it developed following small, potentially subtherapeutic doses of each drug. Although metoprolol was better tolerated, the practical benefit of cardioselectivity in those patients with reversible airways disease was negligible.
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PMID:Influence of cardioselectivity and respiratory disease on pulmonary responsiveness to beta-blockade. 615 5

To examine specific cellular markers of inflammation in peripheral blood (neutrophils and eosinophils) and their relationship to respiratory symptoms, we used data from the First National Health and Nutrition Examination Survey (NHANES I). Cross-sectional data were available on a random sample of 6,913 adults aged 30 to 74 years who had American Thoracic Society-National Heart, Lung, and Blood Institute questionnaire information on respiratory symptoms and illnesses, including asthma, chronic bronchitis, dyspnea (grade 3), chronic cough, and chronic phlegm. Information was available on age, race, smoking status, peripheral blood leukocyte count, and differential cell count. These data were analyzed using logistic regression controlling for age, race, sex, and cigarette smoking. Physician-diagnosed asthma was significantly associated only with the eosinophil count (p = 0.001). Physician-diagnosed bronchitis was significantly associated with the neutrophil count (p = 0.012) and marginally associated with the eosinophil count (p = 0.072). Chronic phlegm was also significantly associated with both the eosinophil count (p = 0.049) and the neutrophil count (p = 0.041). Grade 3 dyspnea (p = 0.049) was only significantly associated with the neutrophil count. These data suggest that both peripheral blood neutrophils and eosinophils are associated with a broad range of respiratory symptoms and that the eosinophil may play a role in nonasthmatic respiratory inflammation.
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PMID:Prediction of respiratory symptoms by peripheral blood neutrophils and eosinophils in the First National Nutrition Examination Survey (NHANES I). 840 95

In a primary care setting, nurse-midwives will collaboratively manage common lower respiratory conditions that require pharmacologic therapy. As such, they must maintain up-to-date knowledge about the indications, use, and potential side effects of these medications. This article reviews the drugs most commonly used for the out-patient treatment of pneumonia, asthma, tuberculosis, and bronchitis (both acute and chronic). Differences among common oral antibiotics recommended by the American Thoracic Society are described. Inhaled bronchodilator and anti-inflammatory medications are covered, as well as systemic corticosteroids. The use of isoniazid preventive therapy for latent tuberculous infection is described in detail, with brief mention made of other drugs used for active tuberculosis. Adjunct treatments including immunotherapy, vaccines, oxygen supplementation, and nicotine replacement for smoking cessation also are discussed.
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PMID:Pharmacologic management of common lower respiratory tract disorders in women. 923 67

This survey was part of a health monitoring system operated in the vicinity of a new power plant in Israel. The aim of this analysis was to determine whether a temporal trend of increased prevalence of asthma can be observed among cohorts of same-aged children, between 1980 and 1989. Schoolchildren were followed up between 1980 and 1989. They performed pulmonary function tests (PFTs), and their parents filled out American Thoracic Society-National Heart and Lung Institute (ATS-NHLI) health questionnaires. This report deals with the changes in the prevalence of asthma, related respiratory conditions and PFT in four cross-sectional data sets gathered among eighth-grade schoolchildren (aged 13-14 yrs). A highly significant (p=0.0005) increase in the prevalence of asthma (from 5.6% in 1980 to 11.2% in 1989), and of wheezing accompanied by shortness of breath (p=0.0009) could be observed. A similar trend could not be found for the prevalence of bronchitis among these children. PFTs of children suffering from asthma or from wheeze accompanied by shortness of breath were lower than those of healthy children. Changes in prevalence of background variables over time could not explain these findings. The significant rise in the prevalence of asthma coupled with reduced pulmonary function test results among asthmatic children, seems to reflect a true increase in morbidity. Temporal changes in the prevalence of background variables as well as proximity to the power plant could not explain this trend.
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PMID:Changing prevalence of asthma among schoolchildren in Israel. 938 54

Lower respiratory tract infection (LRTI) is one of the major health problems in developing countries such as Indonesia. According to the National Household Health Survey conducted by the Ministry of Health in 1992, LRTIs still rank fourth as the main cause of death in Indonesia. The problem of LRTIs could be simply managed as long as the causative organism can be identified and the proper antibiotic known. In some occasions, it is not quite so easy to identify the causative micro-organism, especially in lower tract infections. There are several methods of obtaining specimens from LRTIs for cultures. The easiest, most simple way is to collect expectorated sputum. Unfortunately, because of the high rate of contamination by upper respiratory tract flora, this method is not reliable. Recognizing the difficulties with routine expectorated sputum cultures, two alternative approaches have been suggested. One approach is to bypass potential expectorated sputum 'contaminants' in the oropharynx by transtracheal aspiration or transthoracic aspiration. The second approach is to modify the usual technique of processing expectorated sputum by either washing techniques or by quantitative cultures. Azithromycin and clarithromycin are chemically related to macrolide erithromycin. Both antibiotics retain the traditional macrolide spectrum of activity against gram-positive and atypical pneumonia pathogens, while demonstrating improved activity against gram-negative bacteria. The American Thoracic Society (ATS) recommended the use of macrolide for outpatients with community-acquired pneumonia, without comorbidity and 60 years of age or younger. A total of 34 outpatients with acute LRTIs were open-comparative, randomly allocated to treatment with the new macrolide in Persahabatan Hospital, Jakarta, 1996. The purposes of this study were: (i) to identify the causative micro-organisms; and (ii) to evaluate the clinical efficacy of the new macrolide in these infections. Azithromycin 500 mg was given orally once a day for 3 days and was administered 1 h before or 2 h after every meal. Clarithromycin 500 mg was given orally every 12 h for 10 days. The diagnosis of the patients were: 16 with pneumonia, 10 with acute bronchitis and 8 with acute exacerbation of chronic bronchitis. In this study of 34 patients, the sputum specimens were washed with N acetylcysteine before culture and we could only detect micro-organisms in one patient. Before treatment, we found 47 strains in 33 (97.05%) patients and after treatment we found five strains. From serological examination, only four (11.76%) atypical bacterial were detected. The most frequently found microorganisms were 23 strains of Klebsiella pneumoniae (40.42%), 10 of Streptococcus alpha haemolyticus (21.26%), five of Streptococcus pneumoniae (10.63%) and five of Staphylococcus aureus (10.63%). The atypical bacterial were: two Legionella pneumophila, one Mycoplasma pneumoniae and one Chlamydia pneumoniae. The clinical efficacy of new macrolides were 100% and the bacteriological responses with eradication of 94.12% vs 70.59% of isolates in the azithromycin and clarithromycin groups are shown in Table 1. There were no adverse reactions detected in the two treatment groups until the end of the study.
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PMID:The pattern of micro-organisms and the efficacy of new macrolide in acute lower respiratory tract infections. 969 20

During the spring of 1995, schoolchildren aged 7-13 y who lived in a rural area in Israel were studied. These children lived in two communities: in one community, the population was exposed to pollution from a cement factory and quarries; the population of the second community was not exposed to pollution from these sources. The children from participating schools performed forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, forced expiratory flow at 50%, and forced expiratory flow at 25%. Parents completed an American Thoracic Society-National Heart and Lung Institute health questionnaire, which included information about respiratory symptoms and diseases of the children and information about background variables. A trend of higher prevalence of most respiratory symptoms occurred in 638 children who were growing up in the community that bordered the industrial zone, compared with 338 children from the unexposed community. Cough without cold, sputum without cold, and cough accompanied by sputum were the most prevalent symptoms. Asthma diagnosed by a physician was reported more frequently for children who lived near the polluting sources. No consistent trend of reduced pulmonary function tests was observed among children who lived in the polluted community; however, peak expiratory flow was significantly lower among these children. Odds ratio values, calculated from logistic regressions in which we controlled for respiratory problems among parents, mothers who smoked, crowding index, education of mothers, and residential heating, were 3.6 (p value for model = .244) for cough without cold, 4.0 (p value for model = .333) for asthma, and 2.2 (p value for model = .753) for asthma and/or bronchitis in the polluted area, compared with 1.0 in the low-pollution community. Total suspended particulate matter and levels of airborne particles less than 10 microns, measured in the community bordering the industrial zone, very often violated the relevant 24-h Israeli standards of 200 microg/m3 and 150 microg/m3, respectively.
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PMID:Respiratory problems associated with exposure to airborne particles in the community. 1044 37


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