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The aging process results in changes in pulmonary physiology that make the elderly population more susceptible to pulmonary disease. These physiologic changes also alter the clinical presentation of such diseases, making the diagnosis and treatment of pulmonary disorders particularly challenging for the clinician. It is important for the clinician to have a high index of suspicion for pulmonary disorders to make the proper diagnosis. It is essential to keep in mind the subtle differences between pulmonary diseases in the elderly compared with younger patients.

The identification of risk factors and optimization of respiratory status are crucial to the successful management of patients who have pulmonary disease and are undergoing a surgical procedure. This article explores the approach to pulmonary patients, from the preoperative assessment to the intraoperative and postoperative periods. The management of specific pulmonary disorders in the perioperative period is discussed.

The lung biopsy is widely recognized as a valuable tool for the diagnosis and management of diverse pulmonary disorders. The transbronchial lung biopsy, open lung biopsy, and video assisted thoracoscopic surgery biopsy are the principal tools that have been developed for obtaining lung tissue for histopathological examination. Whereas these various types of lung biopsies are highly sensitive and specific tests available for diagnosis, they may be fraught with potential problems. This review hopes to inform the reader of the indications and limitations of the lung biopsy.

The diagnosis and classification of idiopathic interstitial pneumonias continue to be problematic areas for pathologists. The recently proposed American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias defines specific clinical, radiologic, and pathologic criteria for each of the pulmonary disorders that encompass the idiopathic interstitial pneumonias. In this review, the highlights of this classification are presented, along with recommended guidelines for handling lung biopsy specimens and diagnosing interstitial lung diseases.

In Deutschland haben Rehabilitations- und Trainingsprogramme zur klinischen und funktionellen Verbesserung von Patienten mit chronisch-obstruktiven Atemwegserkrankungen eine lange Tradition. Dies gilt insbesondere fur stationare Programme. Aufbauend auf Erfahrungen des Auslandes wird jedoch inzwischen ambulanten oder hauslichen Programmen zunehmend Beachtung geschenkt. Ein zentraler Bestandteil der Programme ist korperliches Training. Dahinter steht die Erwartung, mit relativ geringem Aufwand den klinischen Zustand, sowie Lebensqualitat, Krankheitsverlauf und Prognose des Patienten verbessern zu konnen. Erste Erfahrungen liegen - neben dem Asthma bronchiale - insbesondere bei der COPD vor. Die Daten legen nahe, dass korperliches Training die Exazerbationsraten senken kann und dieser Effekt mit minimalem Betreuungsaufwand erreichbar ist. Vordringliches Ziel kunftiger Untersuchungen scheint daher die Entwicklung und Evaluierung praxisnaher, minimal aufwendiger Trainingsprogramme. Inwieweit diese Programme auf andere Lungenerkrankungen ubertragbar sind, sollte ebenfalls gepruft werden. In Germany there is a long tradition of rehabilitation and exercise training programs to improve the clinical state and physical function of patients with chronic obstructive pulmonary diseases. This is particularly true regarding inpatient rehabilitation. Based on experiences gained in other countries, outpatient and home-based programs are currently getting more attention. One of the key components of pulmonary rehabilitation is exercise training which can be expected to exert direct and indirect beneficial effects on physical performance, health-related quality of life and even the progress of the disease. Most of the available experience refers to patients with COPD - besides those with bronchial asthma. The data available so far suggest that exercise training programs can reduce exacerbation rates and that this effect is achievable by minimal personal assistance. Thus the most important aim of future studies seems to be the development and evaluation of training programs which are efficient but also easy to implement and minimally expensive. Furthermore it needs to be studied whether such programs can be transferred to pulmonary disorders other than obstructive airway diseases.

Respiratory therapists are healthcare professionals taking care of patients with pulmonary disorders. They are an allied health specialty, practicing under medical direction. The professionalism of nurses and therapists must grow up to act successfully in new fields of medicine, where evidence-based independent action is necessary. Specialized therapists can help us coordinate separated processes (diagnoses, therapy and nursing). The profession "Respiratory Therapist" was created in the United States 50 years ago. We intend to introduce this profession also in Germany. We follow many other countries who have already taken this step. We hope that we can reach yet a higher quality of patient care.

Kinetic therapy improves oxygenation, thus decreasing length of stay for patients with pulmonary disorders, such as nosocomial pneumonia, atelectasis, acute respiratory distress syndrome, and acute lung injury.

▪ Abstract Gene therapy as a treatment modality for pulmonary disorders has attracted significant interest over the past decade. Since the initiation of the first clinical trials for cystic fibrosis lung disease using recombinant adenovirus in the early 1990s, the field has encountered numerous obstacles including vector inflammation, inefficient delivery, and vector production. Despite these obstacles, enthusiasm for lung gene therapy remains high. In part, this enthusiasm is fueled through the diligence of numerous researchers whose studies continue to reveal great potential of new gene transfer vectors that demonstrate increased tropism for airway epithelia. Several newly identified serotypes of adeno-associated virus have demonstrated substantial promise in animal models and will likely surface soon in clinical trials. Furthermore, an increased understanding of vector biology has also led to the development of new technologies to enhance the efficiency and selectivity of gene delivery to the lung. Although the promise of gene therapy to the lung has yet to be realized, the recent concentrated efforts in the field that focus on the basic virology of vector development will undoubtedly reap great rewards over the next decade in treating lung diseases.

Background: Oxidative stress has repeatedly been linked to the pathogenesis of pulmonary disorders like asthma and chronic obstructive pulmonary disease. Measuring glutathione (GSH) in induced sputum (IS) offers a noninvasive tool to study oxidative stress in airway diseases. Objectives: This study assessed the stability of GSH in sputum supernatant under varying conditions. Methods: GSH in IS of 14 (7 healthy, 4 chronic obstructive pulmonary disease, 3 allergic rhinitis) nonsmoking subjects was quantified spectrophotometrically. The stability of GSH in supernatant was analyzed over 24 h under different ambient conditions (room temperature and cooling at 4°C). Reproducibility of GSH measurements in immediately processed and frozen supernatant (+72 h) was expressed by intraclass correlation coefficient (Ri) and coefficient of repeatability (CR). Results: GSH recovery in supernatant decreased in a time- and temperature-dependent manner. Samples stored at 4°C and room temperature showed a rapid decline of stability after 2 h. Mean GSH concentrations in IS after freezing (–20°C) and thawing after 72 h were not significantly different from GSH values measured immediately after processing of the samples (immediate processing: 17.9 ± 13.9 µM; 72 h freezing: 16.4 ± 12.9 µM, p = 0.2). The reproducibility between immediately processed and frozen samples was excellent (Ri = 0.97; CR = 5.7 µM). Conclusions: Storage of sputum supernatant at room temperature or 4°C leads to a rapid decline of GSH recovery compared with baseline values. Immediate freezing of samples is a suitable and valid alternative to rapid processing and allows collection and shipment of samples for subsequent analysis.

The West African countries have infrequent Cardiac Surgery Centers. Mitral valve replacement (MVR) from such countries raises important postoperative preoccupations. The aim of this study is to report indication and short-term outcomes of MVR at the Cardiac Surgery Center of the University Hospital in Dakar (Senegal). This is a retrospective analytical and descriptive study covering a period of 19 months (From January 2015 to July 2016). All patients with MVR associated or not with tricuspid valve repair were included in this study. Seventy-three (73) patients were eligible. The mean follow-up was 4.2 ± 4 months (range, 1-12). The mean age was 30.4 ± 13 years (range, 9–64). There were 74% of female patients, 53% were in New York Heart Association class III. Preoperative diagnoses were mitral stenosis (31.5%); mitral regurgitation (37%) and mixed mitral disease (31.5%). Crystalloid cardioplegia was performed in 92%, mean CPB time was 79 ± 21 min, mean cross clamp time was 58 ± 15.6 min. Mitral valve exposure was performed by left atriotomy (93%); 99% of mechanical prosthesis was performed. Tricuspid valve repair was performed concomitantly in 48% of patients. Overall Hospital mortality was 8%. Postoperative complications were low output syndrome (19%), pneumonia (12%), surgical wound infection (8%), Pleural effusion (7%). During follow-up, no valve-related morbidity and mortality was recorded. Mechanical valve replacement in Senegal has acceptable early outcomes in terms of morbi-mortality. Preoperative diagnoses were represented in equivalent proportions by mitral stenosis; mitral regurgitation and mixed mitral disease. Our complications were predominantly low output syndrome and pleura pulmonary disorders.

Side effects of Anti-Tuberculosis Drugs is a problem in the treatment of tuberculosis patients. In Barru Regency, the number of pulmonary TB patient visits in the outpatient and inpatient units in 2014–2016 was still high. Based on these data, it is deemed necessary to conduct research on the causes of cure rates in only 73% of the total users of pulmonary TB drugs, in terms of the side effects of anti-tuberculosis drugs, pulmonary disorders and gastric disorders. This study was conducted on Agustus, 2017 to January, 2018; using cross sectional approach. Subject of this study were 75 tuberculosis patients with BTA+ and side effects of Anti-Tuberculosis Drugs on the lungs and stomach, selected by total sampling. Data were obtained through interview, then analyzed by using path analysis. It is known that the pathways of influence were significant (T-value> 1.96) were knowledge on immune system, type of drug on immune system, knowledge on side effect of drug and type of drug on side effect of drug. Thus, the level of knowledge and types of drugs directly affect the immune system, as well as the side effects of drugs. Several factors that directly affect the side effects of anti-tuberculosis drugs are the level of knowledge and type of drug. Increased knowledge will reduce the side effects of the drug, because the patient makes an effort to neutralize the effect.

Cigarette smoke exposure generates both acute and chronic inflammatory cell infiltrates that are operative in numerous pulmonary disorders. Cigarette smoke induces a complex signaling cascade within the lung mediated by epithelial cells, lymphocytes, macrophages, and others. The net result is a destructive and self-perpetuating inflammatory environment that is capable of creating lung diseases such as emphysema, while simultaneously fueling lung tumor growth using both matrix-dependent and -independent means.

Maintaining a healthy blood–gas barrier (BGB) is integral to retaining the lung’s primary role. Disruption in BGB is an early pathological event in a number of acute and chronic life-threatening pulmonary disorders. Thus, understanding the molecular processes that modulate the barrier function of the BGB is vital to aid in the development of new treatment paradigms. A plethora of air- and blood-borne environmental challenges modulate signalling pathways that can severely compromise the ability of the BGB to maintain an effective barrier function. Successful rapid reconstitution of pulmonary epithelial and endothelial monolayers and restoration of junctional complexes following injury is essential to limit lung tissue damage, permit effective blood–gas exchange, and to preserve normal tissue architecture. An inability to withstand these environmental challenges and efficiently affect endogenous reparative processes predisposes susceptible individuals to the development of lung diseases. This chapter explores the molecular mechanisms that are fundamental in modulating the pulmonary BGB, and provides examples of how these molecular mechanisms contribute to the susceptibility and development of pulmonary diseases.

The respiratory surface in the mammalian lung is stabilized by pulmonary surfactant, a membrane-based system composed of multiple lipids and specific proteins, the primary function of which is to minimize the surface tension at the alveolar air-liquid interface, optimizing the mechanics of breathing and avoiding alveolar collapse, especially at the end of expiration. The goal of the present review is to summarize current knowledge regarding the structure, lipid-protein interactions and mechanical features of surfactant membranes and films and how these properties correlate with surfactant biological function inside the lungs. Surfactant mechanical properties can be severely compromised by different agents, which lead to surfactant inhibition and ultimately contributes to the development of pulmonary disorders and pathologies in newborns, children and adults. A detailed comprehension of the unique mechanical and rheological properties of surfactant layers is crucial for the diagnostics and treatment of lung diseases, either by analyzing the contribution of surfactant impairment to the pathophysiology or by improving the formulations in surfactant replacement therapies. Finally, a short review is also included on the most relevant experimental techniques currently employed to evaluate lung surfactant mechanics, rheology, and inhibition and reactivation processes.

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There are a large number of pulmonary disorders some of which present challenges in management. Role of genetic ancestry in lung function is under investigation. There is still limited information on pharmacogenomics and pharmacogenetics of pulmonary therapeutics. Personalized approaches to some pulmonary diseases will be described briefly as examples in this chapter.

Aimed to investigate the main pulmonary changes found in cattle intended for slaughter slaughtering and industrial Refrigerator Natal, RN, from October 2013 to January 2014. Inspection was performed post mortem advocated by Regulation inspection of products of animal origin 2386 animal animals were divided into two groups: the coming Mossoro or from other states. Data were collected through records and analyzed using descriptive statistics (percentage) and frequency of variables found by chi square test. The results showed that 71 % (n = 1695) examined the lungs were considered healthy and 29 % ( n = 691) had some type of injury . Furthermore, 48.7 % (n = 337) of the convictions were of animals from Mossley and 51.3 % (n = 354) from other states . With regard to pulmonary disorders , emphysema (28.8 %) , congestion (28 %) , aspiration of blood ( 12.3 %), pneumonia (8.8%) , aspiration of rumen contents (8 %) , hyperemia were observed ( 8%), abscess (2.7%) , edema (2.4%) and pneumonia (1.0%). Both groups showed similar results when compared to each other, except for abscess (p = 0.02) and agonal aspiration of blood ( p = 0.00 ) in the animals of the region of Natal, edema (p = 0.04) and emphysema ( p = 0.03 ) for animals from other regions of the country. It was concluded that animal stunning at slaughter is important, influencing the appearance of pulmonary changes, being related to a standard of efficiency, adequacy and accuracy training on stunning and people involved in the process.

Molecular epidemiological studies have identified a number of genetic variations within immune/inflammatory genes as susceptibility factors for common immune-mediated/chronic inflammatory diseases, including many pulmonary disorders. Data are now accumulating on their role in diseases of occupational and environmental origin. Some susceptibility factors are shared between different pulmonary disorders, indicating a common immunological and genetic background. This chapter focuses on immunogenetic predisposition to pulmonary disorders, particularly those that can be related to occupational exposures such as occupational asthma, chronic beryllium disease, coal workers' pneumoconiosis, and silicosis.

Interstitial lung diseases (ILDs) are a heterogeneous group of >100 pulmonary disorders. ILDs are characterized by an irreversible architectural distortion and impaired gas exchange; however, there is great variability in the clinical course. ILD diagnosis requires a combination of clinical data, radiological imaging and histological findings (when a lung biopsy is required). At the same time, successful management of ILD patients strictly depends on an accurate and confident diagnosis. In this context, the detection of reliable biomarkers able to identify ILD subtypes, avoiding lung biopsy, as well as the capacity to stratify patients and predict over time the disease course, has become a primary aim for all research studies in this field.

Respiratory disorders, including occupational and environmental lung diseases, are prevalent. Physicians are frequently called upon to determine impairment and aid in the assessment of disability caused by these conditions, either as the treating physician or as an independent medical examiner. In this article we reviewed the role of physicians in determining the presence and severity of pulmonary disorders. A comprehensive clinical assessment and appropriate standardized tests, to objectively characterize the severity of impairment, are the key elements of the evaluation. This assessment may also include the physician's opinion regarding causative factors. Finally, disability determination is made by nonclinicians, through administrative means, based on the degree of impairment and a review of circumstances specific to the individual. Knowledge of these components of disability evaluation will help physicians to better serve their patients and supply appropriate data to the adjudicating system.

The concepts of illness behavior (IB), coping (C), and health-related quality of life (HQL) are commonly used in the health field. Nevertheless, there are doubts about their ability to discriminate among groups of patients and to predict anxiety and depression levels in some medical settings. Three groups of patients (ambulatory chronic obstructive pulmonary disease ‘COPD’ patients, hospitalized COPD patients, and surgical lung cancer patients) were evaluated on the basis of these concepts using three standard questionnaires. Discriminant analysis was performed to study the discriminative properties of concepts; the eigenvalues were 3.470 (IB), 0.989 (C) and 5.591 (HQL). Stepwise multiple regression analyses were performed to identify the concepts and the scales that could best predict anxiety and depression. For anxiety, adjusted R2 were 0.408 (IB), 0.140 (C) and 0.633 (HQL); for depression, adjusted R2 were 0.264 (IB), 0.079 (C) and 0.635 (HQL). Coping had the greatest difficulty differentiating among persons suffering from different diseases; the efficiency to predict an affective state was poor in IB, C, and HQL. Some implications of the results are discussed.

Summary Pulmonary disorders remain an important complication of HIV infection, even in the current era of potent antiretroviral therapy. Using an integrated approach that combines radiographic pattern recognition with knowledge of a patient's clinical symptoms, laboratory data, immune status level, demographic information, and drug therapy can enhance the interpretation of imaging studies in HIV-infected patients. Although chest radiography remains the mainstay of imaging the HIV-positive patient with respiratory symptoms, CT plays an increasingly important secondary role in selected cases.

Background: Radiopharmaceuticals are regarded as safe by the nuclear medicine community, but up to now, no survey has been conducted with from the perspective of pharmacovigilance. Objective: To describe the adverse reactions to radiopharmaceuticals (ARRPs) reported to the French Pharmacovigilance Database (FPVD). Methods: We selected and described all reports encompassing at least one radiopharmaceutical in the FPVD. The annual incidence of reported ARRPs used in diagnosis was also estimated. Results: From 1989 to 2013, 304 reports of ARRPs were identified (43.0% serious, 12 deaths) in 54.6% women and 45.4% men; the median age was 58 years. Five therapeutic radiopharmaceuticals (131I-sodium iodide, 131I-lipiodol, 89Sr-chloride, 153Sm-lexidronam, and 90Y-ibritumomab-tiuxetan) were involved in 48 reports (97 adverse reactions: 86.6% serious, 9 deaths). Pulmonary disorders represented 44.3% of ARRPs used for therapy, mainly related to 131I-lipiodol. There were 34 diagnostic radiopharmaceuticals involved in 256 reports (451 adverse reactions: 38.1% serious, 3 deaths); 8 diagnostic products (99mTc-oxidronate, 18F-fluorodeoxyglucose, 99mTc-tin pyrophosphate, 99mTc-tetrofosmin, 99mTc-dimercaptosuccinic acid, 201Tl-chloride, 99mTc-sestamibi, and 111In-pentetate) accounted for two-thirds of ARRPs. The most frequent adverse reactions were skin (34.4%), general (18.2%), nervous (9.0%), and gastrointestinal disorders (7.0%). There were 25 cases of altered images and 10 medication errors. The annual incidence of reported adverse reactions ranged from 1.2 × 10−5 to 3.4 × 10−5 diagnostic administrations. Conclusions: Reported ARRPs occurred rarely and were more serious in the therapeutic than in the diagnostic field. The notification of ARRPs was able to provide new guidance for safe use, as was the case for 131I-lipiodol. Therefore, it is important to report ARRPs to a pharmacovigilance system.

Subjects who do not pass ventilator weaning parameters but whose ambient air oxyhemoglobin saturation can be normalized by mechanical insufflation-exsufflation (MIE) can be extubated to continuous noninvasive ventilatory support (CNVS) with MIE used to maintain extubation. Our aim was to study MIE-associated changes in breathing tolerance, pulse oximetry, and vital capacity (VC) for consecutive unweanable subjects.A retrospective chart review was performed for consecutively referred intubated subjects with single-organ (respiratory muscle) failure. At presentation, CO2 was normalized by adjusting ventilator settings and VC was measured (point 1). Then, MIE was used via the tube up to every h until oximetry remained ≥ 95% on ambient air and VC was remeasured (point 2) immediately before extubation. Subjects who could not meet ventilator weaning criteria and had no ventilator-free breathing ability upon extubation to CNVS were enrolled. Post-extubation, the MIE was used to maintain oximetry ≥ 95% in room air. VC and breathing tolerance were remeasured within 3 weeks (point 3).Ninety-seven of 98 subjects were successfully extubated despite 45 having been CNVS-dependent for 4 months to 18 y before being intubated. Sixty-nine of the 98 were intubated for 24.9 ± 22 (range 1-158) d and failed 0-6 (mean 1.7) extubation attempts before being transferred and successfully extubated in 2.24 ± 1.78 (range1-8) d to CNVS. VC increased by 270% (P.001) from points 1 to 3. Weaning from CNVS to part-time NVS was achieved by all 52 subjects who had not been CNVS-dependent before intubation. One subject underwent tracheotomy.Many unweanable subjects can be extubated to CNVS and MIE. The latter can normalize O2 saturation, increase VC, and facilitate extubation.

Pregnancy is associated with some profound changes in the cardiovascular, respiratory, immune, and hematologic systems that impact the clinical presentation of respiratory disorders, their implications in pregnancy, and the decisions to treat. In addition, concerns for fetal well-being and safety of various interventions complicate the management of these disorders. In many circumstances, especially life-threatening ones, decisions are based upon a careful assessment of the risk benefit ratio rather than absolute safety of drugs and interventions. In this chapter, we review some of the common respiratory disorders that internists or obstetricians may be called upon to manage.

The 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors (statins) are used extensively in the treatment of hyperlipidemia. They have also demonstrated a secondary benefit in a variety of other disease processes, actions which are known as pleiotropic effects. Review of the current pulmonary literature suggests a potential advantage of statin usage in a variety of pulmonary conditions. Our paper serves as a focused discussion on the pleiotropic effects of statins in the most common pulmonary disorders.

Interstitial lung diseases (ILD) refer to a group of more than 150 parenchymal lung disorders. High-Resolution Computed Tomography (HRCT) is the most essential imaging modality of ILD diagnosis. Nonetheless, classification of various lung tissue patterns caused by ILD is still regarded as a challenging task. The current study focuses on the classification of five most common categories of lung tissues of ILD in HRCT images: normal, emphysema, ground glass, fibrosis and micronodules. The objective of the research is to classify an expert-given annotated region of interest (AROI) using a bag of visual words (BoVW) framework. The images are divided into small patches and a collection of representative patches are defined as visual words. This procedure, termed dictionary construction, is performed for each individual lung texture category. The assumption is that different lung textures are represented by a different visual word distribution. The classification is performed using an SVM classifier with histogram intersection kernel. In the experiments, we use a dataset of 1018 AROIs from 95 patients. Classification using a leave-one-patient-out cross validation (LOPO CV) is used. Current classification accuracy obtained is close to 80%.

I should like to start by thanking Professor Gibson and all members of the Programme Committee for asking me to give this Millennial Lecture. I am, of course, greatly honoured at having been chosen for this, a once every one-thousand years event. One of the things Professor Gibson refrained from saying in his overly flattering introduction is that I actually started my medical career back in the first half of the last century, a long time ago. So I have been witness to over50 years of medical progress – and what a half century it has been! But that is not what I am going to talk about. What I propose to do this morning is, first of all, to discuss briefly some of the remarkable achievements in pulmonary medicine and the men and women who made them during the recently departed millennium. Consequently, I will start my review in the year 1000. Then, I will reflect on the evolution and present deplorable status of two of mankind's deadliest scourges, both of them chiefly pulmonary disorders, one practically as old as human beings themselves, and the other practically brand new. And finally, I will make some suggestions as to how the members of the societies that are sponsoring this World Congress on Lung Health can help solve a few of the existing problems. May I remind you that as the title of my talk indicates, I bring you both good news and bad news. The year 1000 marked the end in Europe of the formless Dark Ages and the beginning of the slightly more progressive Medieval Period; culture and enlightenment were considerably more advanced in Asia at the time. There isn't much information available about ordinary life in Europe in the year 1000, but it has been characterized as “unimaginably …

Sarcoidosis is a systemic granulomatous disease of unknown etiology. It has diverse clinical manifestations, most frequently including pulmonary disorders. It is associated with immunological abnormalities, the intricacies of which have yet to be clearly delineated. In the immunologically susceptible individual, genetic, environmental, nutritional, and socioeconomic factors may play a governing role in its development. Sarcoidosis is a diagnosis of exclusion established by clinical manifestations, radiologic findings, and histologic evidence of noncaseating epithelioid-cell granulomas in >1 organ. We will discuss parameters that are helpful in making this diagnosis.

While MR imaging with tagged magnetization has shown greatutility in the study of muscle mechanics, the evaluation of pul-monary mechanics has long been hindered by the technicaldifficulties in MR imaging of lung parenchyma. In this study, afast MR grid-tagging technique is described for dynamic as-sessment of regional pulmonary deformation. The method isbased on a fast FLASH sequence with short TR and short TE.Tagging was achieved by using double DANTE pulse train orinversion pulses. Our results show that this technique is able todetect changes of the tagging grid caused by physiologicaldeformation of the lung. Quantitative analysis of the data showsthat this method is capable of assessing local pulmonary me-chanics. The application of this technique could improve ourunderstanding of ventilatory control, and thus provide a uniquemetric for assessing pulmonary disorders. Magn Reson Med45:24–28, 2001. © 2001 Wiley-Liss, Inc.Key words: MRI; grid tagging; SPAMM; lung; pulmonary me-chanics

Hyponatraemia is the commonest electrolyte abnormality in clinical practice, and is the biochemical manifestation of a huge variety of illnesses. It is a common complication of malignancy, neurosurgical conditions, cardiac, liver and renal failure and pulmonary disorders. It is a side effect of many drugs and a frequent finding in the elderly, particularly those in long-stay institutions. Perhaps, because of the fact that hyponatraemia is a complication of so many disparate disorders, it has not traditionally fitted easily into the aegis of a single ‘ology’; endocrinologists, renal physicians, geriatricians and internists may all assume responsibility for the diagnosis and treatment of hyponatraemia, according to the profile of the hospital and the clinical interests of the specialists which they employ. In some hospitals, there is no designated specialist who takes an interest in hyponatraemia. The evidence in the literature suggests that hyponatraemia is not only suboptimally investigated, but also poorly managed. The explanation is probably multifactorial – lack of dedicated specialists with an interest in hyponatraemia, poor awareness of investigative protocols and failure to recognise that hyponatraemia contributes to morbidity and mortality – but also that it is perceived that effective treatment is not available. In this supplement, we have reviewed the evidence which suggests that hyponatraemia is associated with significant morbidity. In addition, new complications of mild hyponatraemia are being recognised which challenge the prevalent opinion that mild to moderate hyponatraemia does not require treatment, other than that directed to the underlying causative illness. We further discuss the potential role for the vaptans, the new aquaretic vasopressin antagonists, in the management of euvolaemic hyponatraemia.

The purpose of this study was to evaluate the accuracy of a portable blood lactate analyser for bovine blood and to study the relevance of plasma lactate concentration in the prognosis of bovine pulmonary disorders. Measurements with the portable analyser were highly correlated (R = 0.94, P

Pulmonary disorders triggered by inhalation of occupational and environmental mineral particulates can be endpoints of a chronic inflammatory process in which alveolar macrophages (AMs), as a first line of defense, play a crucial role. The biological processes involved in particulate-induced activation of AMs include indirect or direct interactions of particulates with the cell membrane, subsequent stimulation of signal transduction pathways, and activation of gene transcription. Depending on the nature of particulate involved, particulate-induced activation of AMs has been shown to result in the release of potent mediators, such as reactive oxygen and nitrogen species, cytokines, eicosanoids, and growth factors. The prolonged and enhanced production of such effector molecules may result in a complex cascade of events that can contribute to the development of pulmonary disorders. This paper will give a short review of the present knowledge of AM interaction with inhaled mineral particulates and of the possible implications these interactions may have in the development of pulmonary disorders.

Background Occupational Asthma (OA) is a common disorder attributable to causes and conditions found in the workplace. Occupational asthma may have an immunologic or nonimmunologic basis and may be caused by several hundred agents. A number of factors may increase the risk of developing OA including genetic, industrial, meteorologic, social, and medical factors. Methods The diagnosis is best made by fulfilling well-defined clinical criteria by way of a meticulous and oftentimes arduous evaluation. Pre-existing asthma and allergy, along with other special variants of asthma and unrelated pulmonary disorders which can masquerade as asthma, must be ruled out. Conclusion Convincing physiologic evidence that demonstrates a cause-and-effect relationship must be obtained before a definitive diagnosis of work-related asthma is made.

In this issue of Respiratory Care, Bach et al[1][1] report the successful extubation of 97 of 98 subjects with profound respiratory muscle weakness using mechanical insufflation-exsufflation with the CoughAssist device, which promotes secretion removal and reverses atelectasis. To be considered for

Objective We report 2 cases of oral hairy leukoplakia (OHL) in patients without HIV and present a comprehensive review of OHL in HIV-negative individuals. Study design Two cases of non-HIV-associated OHL are described. A PubMed search identified previously reported cases. The attributes of those cases were ascertained. Results OHL was confirmed in both of our cases. Both patients used inhaled steroids for pulmonary disorders, and were found to have depressed levels of immunoglobulin M. Additionally, 76 cases were identified in the literature. The condition occurred in association with various medical conditions, with the majority of patients on immunosuppressant medications (67 of 76). Systemic drugs were implicated most frequently. The condition has also been reported in healthy individuals (6 of 76). Conclusions Although thought of as an HIV/AIDS-associated condition, OHL can develop in patients without HIV, including healthy individuals. There is a strong correlation between the use of immunosuppressants and development of OHL in these patients.

Pulmonary diseases diagnostics always occupies one of the key positions in medicine practices. A large variety of high technology methods are used today, but none of them cannot be used for early screening of pulmonary diseases. We discuss abilities of methods of IR and terahertz laser spectroscopy for noninvasive express diagnostics of pulmonary diseases on a base of analysis of absorption spectra of patient’s gas emission, in particular, exhaled air. Experience in the field of approaches to experimental data analysis and hard-ware realization of gas analyzers for medical applications is also discussed.

Respiratory infections in animal species are as ubiquitous as they are in humans. Species that may be affected include mammals, birds, and reptiles. In these animal species some viruses primarily infect the respiratory tract, while other viruses infect non-respiratory organs. Viruses are generally classified according to the type of their nucleic acid, their protein structure, and whether or not they have a lipid-containing envelope surrounding the viral particle. In general, most viruses gain entry into the lungs via the conducting airways. In nonprimate mammalians these infections are most prominent in the cranioventral lung lobes because of their horizontal position. Table 24.1 lists some of the major viruses that cause pneumonia and other lung diseases in animals.

Lung surfactant is crucial for optimal pulmonary function throughout life. An absence or deficiency of surfactant can affect the surfactant pool leading to respiratory distress. Even if the coupling between surfactant dysfunction and the underlying disease is not always well understood, using exogenous surfactants as replacement is usually a standard therapeutic option in respiratory distress. Exogenous surfactants have been extensively studied in animal models and clinical trials. The present article provides an update on the evolution of surfactant therapy, types of surfactant treatment, and development of newer-generation surfactants. The differences in the performance between various surfactants are highlighted and advanced research that has been conducted so far in developing the optimal delivery of surfactant is discussed.

Pulmonary disorders are among the most common causes of admission to an intensive care unit and frequently seen in acute care medicine. The following formulas and facts are presented to aid in the diagnosis and management of patients presenting to the emergency department and the intensive care unit (ICU) with pulmonary conditions. Some of the formulas are not useful in the clinical area; however, their understanding is of paramount importance in understanding the normal and abnormal pulmonary physiology and therefore cannot be excluded from this chapter.

Gravity exerts an effect on the distribution of intrapulmonary ventilation. A study on the detection of gravity-dependent inhomogeneity of ventilation by a functional EIT technique is presented. The study was performed on five human subjects, whose ventilation distribution was modified by changes in body position. The subjects were studied during spontaneous tidal breathing. The qualitative and quantitative analysis of the functional EIT images revealed that the ventilation is higher in the dependent lung regions when compared with the non-dependent ones. These EIT findings correspond to current knowledge of the physiological behaviour of the lungs as derived from the radioactive-gas methods and raise the possibility of applying the less complicated functional EIT in future studies on ventilation distribution in the lungs. This may be of major interest in the monitoring of intensive care patients with severe pulmonary disorders.

The role of reflux in the development of esophagitis, stricture, and Barrett's esophagus is well recognized. However, reflux is not an infrequent cause of atypical chest pain, chronic pulmonary disorders, and pharyngeal and laryngeal changes. Increased insight into the pathogenesis of reflux and the relationship between the gastroesophageal junction and the diaphragmatic crura has led to more effective treatment approaches. Medical therapy, including lifestyle changes, antacids, and systemic agents, is effective in most patients. However, surgery may be necessary in patients with anatomic abnormalities or mechanical dysfunction.