Journal of Respiratory Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Metastasectomy of Pulmonary Metastases from Osteosarcoma: Prognostic Factors and Indication for Repeat Metastasectomy Sun, 08 Mar 2015 09:45:51 +0000 Purpose. To identify prognostic factors for metastatic osteosarcoma patients and establish indication for repeat metastasectomy. Methods. Data from 37 patients with pulmonary metastasis from osteosarcoma who underwent metastasectomy in our institute from 1979 to 2013 were retrospectively reviewed. Results. Prognostic factors analyzed were age, sex, maximal diameter of the tumor at first pulmonary metastasectomy, total number of resected pulmonary metastases at first metastasectomy, number of surgeries, and disease free interval. In our analysis, characteristics associated with an increased overall survival were age > 15 years and fewer metastases (≤3). Of the 37 patients, 13 underwent repeat metastasectomy after the first metastasectomy. Of the 7 patients that underwent only two metastasectomies, three remained disease-free. In contrast, all six patients that underwent three or more metastasectomies died of relapse. Patients who had five or less lesions at second metastasectomy showed better survival compared to those who had six or more lesions. Conclusion. Age > 15 years and number of metastases at first metastasectomy were independent prognostic factors. Metastasectomy may provide curative treatment even in cases requiring repeat surgery. The number of metastases at second metastasectomy may be a potential predictor of the need for repeat surgery. Eri Matsubara, Takeshi Mori, Takamasa Koga, Hidekatsu Shibata, Koei Ikeda, Kenji Shiraishi, and Makoto Suzuki Copyright © 2015 Eri Matsubara et al. All rights reserved. Use of Antiasthmatic Drugs during Pregnancy after the First Trimester and Maternal and Neonatal Outcomes Thu, 13 Nov 2014 07:24:52 +0000 Background. Women with asthma using antiasthmatics during the later part of the pregnancy have an increased risk for obstetric complications and their infants of neonatal complications. Material and Methods. The study is based on a linkage between the Swedish Medical Birth Register and a register of prescribed drugs in Sweden for the years 2009–2011, identifying women who had filled prescriptions for antiasthmatics after the first trimester. Their characteristics, their obstetric history, and the neonatal conditions of their infants were compared with all other women who gave birth. Adjusted Mantel-Haenszel odds ratios were determined. Results. We found an increased risk for a number of maternal conditions but no risk increase for gestational diabetes (after adjustment for body mass index) or for premature rupture of membranes. There was an increase in preterm births for some drugs used at severe asthma and of low birth weight and small for gestational age for most drug combinations. An increased risk was seen for neonatal hypoglycemia, respiratory problems, and low Apgar score. Conclusions. There are many hazards associated with maternal asthma and use of antiasthmatic drugs. Most evidence suggests a disease effect. A careful control of the asthma during pregnancy is important. Bengt Källén and Birgitta Norstedt Wikner Copyright © 2014 Bengt Källén and Birgitta Norstedt Wikner. All rights reserved. The Utility of Rapid On-Site Evaluation on Endobronchial Ultrasound Guided Transbronchial Needle Aspiration: Does It Make a Difference? Wed, 12 Nov 2014 09:16:24 +0000 The purpose of this study was to assess the efficacy of using rapid on-site evaluation (ROSE) for samples taken during endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) at Austin Health, Victoria. This was compared to data collected for cases performed without ROSE. A retrospective analysis was conducted on 188 consecutive patients who underwent EBUS-TBNA from May 2012 to July 2014 whose data was collected prospectively at the time of the procedure. The presence of a cytologist during ROSE resulted in a significant reduction in the number of lesions sampled [mean: 1.5 ± 0.7 (1, 4) versus 1.9 ± 0.8 (1, 4), P = 0.0020] and the number of TBNAs required per case [mean: 3.6 ± 1.4 (1, 8) versus 4.2 ± 1.5 (1, 8), P = 0.0017]. This could potentially result in a shorter procedure time and, ultimately, a reduction in complication rate. The quality of the samples obtained during EBUS-TBNA with ROSE was higher. A larger proportion of samples yielded a satisfactory cell block allowing the potential benefit of additional pathology testing including immunohistochemistry and molecular pathology. In summary, the use of ROSE during EBUS-TBNA was superior to off-site cytological assessment of bronchoscopy specimens. Raymond W. M. Wong, Alesha Thai, Yet H. Khor, Kerryn Ireland-Jenkin, Celia J. Lanteri, and Barton R. Jennings Copyright © 2014 Raymond W. M. Wong et al. All rights reserved. Age and Sex Differences in Sputum Smear Microscopy Results for Acid Fast Bacilli in a Tertiary Care Centre, South India Sun, 09 Nov 2014 11:55:03 +0000 Background and Objectives. Low counts are more difficult to find in microscopic sputum examination and thus are more likely to be missed. In this study, we aimed to estimate the proportion of low-count grading and assessing any age and gender differences in sputum smear grading in a low HIV prevalence setting. Materials and Methods. From the tuberculosis laboratory register information on sputum positivity including the grading of smears, age and gender were extracted for January 2011–December 2011. Smears were examined using Ziehl-Neelsen technique and graded as per the Program Guidelines. Positive smears were classified into low grade positive smears (scanty and 1+) and high grade positive smears (2+ and 3+). Differences in grading of smear based on gender and age were analysed using chi square test. Results. Of 9000 smears examined, 8210 (91.2%) were collected as diagnostic smears from tuberculosis suspects. Low grade positivity was 37.5% among diagnostic smears and 69.6% among follow-up smears. Sputum smears from female examinees had higher proportions of low grade positive smears . Stratification of age and sex within TB suspects had clearly demonstrated the observance of higher low grade positivity among female TB suspects at extremes of age. Palanivel Chinnakali, Kalaiselvi Selvaraj, Pruthu Thekkur, Gomathi Ramasamy, Mahalakshmy Thulasingam, and Kavita Vasudevan Copyright © 2014 Palanivel Chinnakali et al. All rights reserved. Obstructive Sleep Apnea, Excessive Daytime Sleepiness, and Road Traffic Accidents among Interstate Commercial Vehicle Drivers in Nigeria Tue, 14 Oct 2014 08:32:32 +0000 Introduction. Obstructive sleep apnea (OSA) is a growing public health problem in developing countries. However the burden among commercial drivers is not well described. Methods. The Epworth Sleepiness Scale (ESS) and Berlin questionnaire were administered to interstate commercial road transport drivers to assess the tendency to sleep in daytime and the risk of OSA, respectively. Body mass index (BMI), neck, and waist-hip circumferences were measured. Results. Out of 138 commercial drivers, 124 (90%) responded and provided complete data. The mean (SD) age, BMI, neck, and waist circumferences were 40.4 (9.3) years, 28.0 (4.6) kg/m2, 40.0 (3.0) cm, and 92.8 (11.1) cm, respectively. Twenty-two percent had ESS score above 11 and 36% of the respondents had a high risk for obstructive sleep apnea. Adjusting for age, BMI, and waist and neck circumferences, the key predictors of road accidents were ESS score above 11 (OR 3.77, 95% CI 1.18–12.06), self-reported diagnosis of hypertension (OR 4.63, 95% CI 1.46–14.69), and increasing hip circumference (OR 1.12, 95% CI 1.01–1.23). Conclusion. Obstructive sleep apnea is common among commercial interstate road drivers in Nigeria and ESS may be a simple tool for assessing accident risk. Daniel O. Obaseki, Gregory E. Erhabor, Josephine E. Obaseki, Ibukun Abidoye, Akinjide Adebisi, and Babatunde Olaiya Copyright © 2014 Daniel O. Obaseki et al. All rights reserved. The Epidemiology of Upper Respiratory Infections at a Tertiary Care Center: Prevalence, Seasonality, and Clinical Symptoms Thu, 19 Jun 2014 00:00:00 +0000 Improved multiplex PCR detection methods are facilitating the correlation of the etiology of respiratory tract infections with specific symptoms or clinical manifestations. We conducted a retrospective analysis of the incidence of respiratory pathogens and initial symptoms in 1,286 patients at a tertiary care center tested by multiplex respiratory pathogen PCR from July 1, 2012, to June 30, 2013. Rhinovirus/enterovirus (Rhino/Entero) infections were the most prevalent (25.4%) followed by respiratory syncytial virus (RSV) (13.6%) and influenza A (6.2%). Eleven percent of patients were positive for multiple analytes with Rhino/Entero and RSV being the most common combination. Asthma or asthma exacerbation was the most common presenting symptom in patients positive for Rhino/Entero (38.4%) or positive for Rhino/Entero along with RSV or hMPV (34.8%). Of the patients positive for Rhino/Entero and presenting with asthma, 97% were ≤17 years of age. RSV positive patients most commonly presented with respiratory distress (40.3%) followed by asthma (18%) or pneumonia (18%). The most prevalent initial clinical manifestation for influenza was fever (27.4%) followed by respiratory distress (13%) or pneumonia (11.9%). The significant percentage of patients positive for Rhino/Entero virus presenting with asthma supports the role of rhinovirus as an important trigger for asthma exacerbation. Christy S. Stover and Christine M. Litwin Copyright © 2014 Christy S. Stover and Christine M. Litwin. All rights reserved. Explorations of Unilateral Diaphragmatic Paralysis Tue, 01 Apr 2014 00:00:00 +0000 Objective. The aim of the present study was to evaluate sniff test, maximal inspiratory pressure, and presence of paradoxical inspiratory diaphragmatic movements and their diagnostic value in patients referred for suspicion of diaphragmatic dysfunction. Methods. Twenty-two patients (8 men and 14 women, years) with suspected diaphragmatic dysfunction were included. Pulmonary function test was evaluated by spirometry. Diaphragm dysfunction was diagnosed with unilateral phrenic nerve stimulation. Esophageal pressure was recorded during sniff test and maximal static inspiratory movements. Detection of paradoxical diaphragmatic movement was performed with anteroposterior projection of chest X-ray fluoroscopic video. Results. Phrenic nerve stimulation enabled diagnosis of diaphragmatic paralysis in 15 of the 22 patients. The remaining 7 patients had normal explorations. Lung volumes were significantly lower in patients with diaphragmatic paralysis than in control subjects, as maximal inspiratory pressure. No patient with normal diaphragmatic exploration had paradoxical inspiratory movement. The combined diagnostic value of reduced esophageal pressure during sniff test, reduced esophageal pressure during maximal static inspiratory movements, and presence of paradoxical inspiratory movement had a sensitivity of 87% and a specificity of 71%. Conclusion. Our results suggest that, in most cases, a combination of sniff test, maximal inspiratory pressure, and paradoxical inspiratory movement could help to diagnose diaphragmatic dysfunction. Nevertheless, phrenic nerve stimulation remains the best test for assessing diaphragmatic dysfunction. Alexandre Quesnel, Françoise Beuret Blanquart, Jean Paul Marie, and Eric Verin Copyright © 2014 Alexandre Quesnel et al. All rights reserved. Out-of-Pocket Costs of Asthma Follow-Up Care in Adults in a Sub-Saharan African Country Mon, 31 Mar 2014 14:27:50 +0000 Asthma care imposes economic burden on affected patients. Patient costs for asthma care have not been documented in Africa. We aimed to determine the out-of-pocket cost of asthma follow-up care incurred by patients in Nigeria. We conducted a cross-sectional study in three tertiary hospitals in southeastern and northwestern Nigeria. Poorly controlled asthma patients attending a follow-up visit in the respiratory clinic of the hospitals were surveyed. Sociodemographic, health-seeking behavior, and cost data were collected using a structured questionnaire. Of the 110 patients who completed the study, 56 (51%) were females. Also, 72 (65%) of the patients had known about their asthma illness for more than four years. Mean annual direct cost of asthma care was US$368.4 (±228) per patient. Medication cost accounted for the majority (87%) of this cost. Patient costs of care incurred did not differ significantly across age (P = 0.15), education (P = 0.23), marital status (0.49), residence (P = 0.47), or gender (P = 0.65) categories. We conclude that direct cost of care was found to be substantial among poorly controlled asthma patients. Further studies to estimate the costs incurred by patients with exacerbation and differing severity of the disease should be conducted. Cajetan Chigozie Onyedum, Olufemi Olumuyiwa Desalu, Kingsley Nnanna Ukwaja, Chinwe Chukwuka, Nnamdi Ikechukwu Nwosu, and Chijioke Ezeudo Copyright © 2014 Cajetan Chigozie Onyedum et al. All rights reserved. Congenital Central Hypoventilation Syndrome: A Comprehensive Review and Future Challenges Tue, 04 Feb 2014 12:51:49 +0000 Congenital central hypoventilation syndrome is a disorder predisposed by a paired-like homebox PHOX2B gene. A mutation in the PHOX2B gene is a requisite when diagnosing congenital central hypoventilation syndrome. This mutation is identified in 93–100% of diagnosed patients. The mutation regarding this disorder affects the sensors, the central controller, and the integration of the signals within the central nervous system. This, inter alia, leads to insufficient ventilation and a decrease in PaO2, as well as an increase in PaCO2. Affected children are at risk during and after the neonatal period. They suffer from hypoventilation periods which may be present whilst sleeping only or in more severe cases when both asleep and awake. It is important for clinicians to perform an early diagnosis of congenital central hypoventilation in order to prevent the deleterious effects of hypoxaemia, hypercapnia, and acidosis on the neurocognitive and cardiovascular functions. Patients need long-term management and appropriate ventilatory support for improving the qualities of their lives. This paper provides a detailed review of congenital central hypoventilation syndrome, a congenital disorder that is genetic in origin. We describe the genetic basis, the wider clinical picture, and those challenges during the diagnosis and management of patients with this condition. Karin Ljubič, Iztok Fister Jr., and Iztok Fister Copyright © 2014 Karin Ljubič et al. All rights reserved. Inhalation of Nebulized Diesel Particulate Matter: A Safety Trial in Healthy Humans Tue, 04 Feb 2014 00:00:00 +0000 Diesel particulate matter (DPM) has adverse health effects. Examining the underlying pathophysiological mechanisms would be facilitated by the introduction of an exposure method that is safe, portable, and cost-effective. The purpose of this study was to establish a novel method to study DPM exposure via nebulization and an inhalation dose that was safe, yet capable of eliciting an inflammatory response. Ten participants enrolled in this nonblinded, nonrandomized study. Subjects inhaled nebulized 0.9% saline and increasing doses of DPM suspended in 0.9% saline (75, 150, and 300 μg) in a sequential manner. FEV1 was measured repeatedly during the first 2 h after exposure and blood, oximetry, sputum, and heart rate were taken before, 2 h, and 24 h after inhalation challenge. DPM inhalation was well-tolerated at all doses. A decrease in FEV1 was observed after each inhalation challenge (including saline). Inhalation of 300 μg DPM produced a significantly different FEV1 response curve. An increase in particle inclusion-positive sputum macrophages for all DPM doses confirmed that the nebulized particles were reaching the lower airways. Serum GM-CSF was elevated after exposures to 150 and 300 μg DPM. No other inflammatory changes were detected. DPM inhalation via nebulizer is a safe method of delivering low doses of DPMs in healthy people. Sandra C. Dorman, Kaylyn M. Sutcliffe, Jacques Abourbih, and Stacey A. Ritz Copyright © 2014 Sandra C. Dorman et al. All rights reserved. Smoke Exposure Has Transient Pulmonary and Systemic Effects in Wildland Firefighters Thu, 30 Jan 2014 08:05:49 +0000 Respiratory exposure to air pollutants is associated with cardiovascular morbidity and mortality and firefighters have been shown to be at an increased risk of work-related cardiovascular events. Wildland firefighters experience intermittent, intense exposure to biomass smoke. The aim of this study was to characterize the respiratory and systemic effects of smoke exposure in wildland firefighters. Seventeen seasonal firefighters from a northeastern Ontario community were recruited at the beginning of the fire season and baseline measurements obtained; postexposure measurements were made at various times within 16 d of firefighting. Spirometric measurements showed a transient decline in forced vital capacity within 7 d of fire exposure, not evident by 8–16 d. Induced sputum showed a significant increase in macrophages and epithelial cells within 7 d, with evidence that macrophages had internalized particles; such changes were not evident in the second week following exposure. Likewise, peripheral blood analysis revealed significant increases in erythrocytes, hemoglobin, monocytes, and platelets within the first week after fire exposure, which were diminished 8–16 d in postexposure group. We conclude that acute exposure to forest-fire smoke elicits transient inflammatory responses, both in the airways and systemically. Whether these changes contribute to the observed increased risk of cardiovascular events requires further study. Sandra C. Dorman and Stacey A. Ritz Copyright © 2014 Sandra C. Dorman and Stacey A. Ritz. All rights reserved. The Physiologic Effects of an Acute Bout of Supramaximal High-Intensity Interval Training Compared with a Continuous Exercise Bout in Patients with COPD Thu, 24 Oct 2013 08:52:58 +0000 This study compared physiological responses and work performed during a supramaximal high-intensity interval exercise training session (HIIT) and a constant work rate (CWR) exercise session. Fourteen patients with COPD (mean FEV1   % predicted (±SD)) completed an incremental cardiopulmonary exercise test (CPET) and a steep ramp anaerobic test (SRAT) and then two exercise bouts to symptom limitation on separate days, in random order: (1) a CWR trial at 80% of CPET peak work rate (mean  W) and (2) a HIIT trial using repeats of 30 s at 70% of SRAT peak work rate (mean  W) followed by 90 s at 20% of CPET peak work rate. Subjects ceased exercise primarily due to dyspnea for both HIIT and CWR (64% vs. 57%, resp.). End-exercise , HR, dyspnea, and leg fatigue were similar between the two exercise protocols. Average work rate was lower in HIIT than CWR (32 vs. 63 W, ); however, subjects performed HIIT longer (542 vs. 202 s, ) and for greater total work (23.3 vs. 12.0 kJ, ). The supramaximal HIIT protocol was well tolerated and demonstrated similar maximal physiologic responses to constant work rate exercise, but with greater leg muscle work performed and greater peak exercise intensity. Scotty J. Butcher, Madison T. Yurach, Nichole M. Heynen, Brendan J. Pikaluk, Karla J. Horvey, Ron Clemens, and Darcy D. Marciniuk Copyright © 2013 Scotty J. Butcher et al. All rights reserved. Diagnostic Utility of Transbronchial Needle Aspiration in Malignant Endobronchial Lesions: Relevance to Lesions’ Characteristics Thu, 05 Sep 2013 14:26:21 +0000 In this prospective study, we aimed to report our experience with the diagnostic utility of transbronchial needle aspiration (TBNA) in patients with malignant endobronchial lesions detected during routine bronchoscopy. Ninety-four patients were enrolled. TBNA and conventional diagnostic techniques (CDTs: forceps biopsy, brushing, and washing) were performed in all patients. Endobronchial lesions were classified into exophytic mass lesions (EMLs), submucosal disease (SD), and peribronchial disease (PD). The diagnostic yields of TBNA and CDT alone and together were compared according to the lesions’ types, histopathology, and locations. During 3-year period, the addition of TBNA to CDT improved bronchoscopic sensitivity from 70.2% to 94.7% in all lesion types. Addition of TBNA to CDT increased the diagnostic success from 74% to 95% and from 50% to 94% in NSCLC and SCLC, respectively. The diagnostic success was increased in all localizations by the addition of TBNA to CDT, particularly for lesions located at the trachea, main bronchi, and upper lobes. We conclude that the addition of TBNA to CDT increases the diagnostic yield in patients with visible malignant endobronchial lesions, particularly in peribronchial disease, and improves the diagnostic yield of bronchoscopy, in both NSCLC and SCLC and in all bronchoscopic locations, particularly in central and upper lobar lesions. Sherif A. A. Mohamed, Yousef Ahmed, Khaled Hussein, Nashwa M. A. Abd El-Aziz, and Yasser Gamal Copyright © 2013 Sherif A. A. Mohamed et al. All rights reserved.