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Chest. 1999 Mar;115(3):829-35.
Bacterial endotoxin is an active component of cigarette smoke.

Hasday JD, Bascom R, Costa JJ, Fitzgerald T, Dubin W.

Division of Pulmonary and Critical Care Medicine, University of Maryland Medical School, Baltimore, USA. jhasdamaryland.edu

BACKGROUND: Chronic bronchitis in cigarette smokers shares many clinical and histologic features with environmental lung diseases attributed to bacterial endotoxin (lipopolysaccharide [LPS]) inhalation. Experimental LPS inhalation mimics many of the acute effects of cigarette smoke in the lower airway. Therefore, we reasoned that LPS may be a biologically active component of cigarette smoke. DESIGN: The Limulus amebocyte lysate (LAL) assay was used to measure LPS in the tobacco and filter tip components of unsmoked 1R4F experimental cigarettes and commercially available "light" cigarettes, as well as in mainstream (MS) and sidestream (SS) smoke particles generated with an automated smoking machine and collected on ventilator mainflow filters. SETTING AND PARTICIPANTS: Blood LPS activity and plasma cytokine concentrations were measured in groups of healthy smokers and nonsmokers who reported to the walk-in clinic at the Baltimore VA Medical Center for unrelated complaints. MEASUREMENTS: Blood LPS levels were measured by LAL assay and plasma levels of tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6), soluble TNF receptors I and II (sTNFR I and sTNFR II) were measured by enzyme-linked immunosorbent assay. RESULTS: Bioactive LPS was detected in both the tobacco portion (1R4F, 17.8+/-1.0 microg/cigarette; light, 26.8+/-7.3 microg/cigarette [mean+/-SE]) and filter tips (1R4F, 0.67+/-0.55 microg/cigarette; light, 0.70+/-0.39 microg/cigarette) of cigarettes. Bioactive LPS was also detected in both MS (1R4F, 120+/-64 ng/cigarette; light: 45.3+/-16 ng/cigarette) and SS smoke (1R4F, 18+/-1.5 ng/cigarette; light: 75+/-49 ng/cigarette). Although systemic absorption of inhaled LPS may occur, we failed to detect any differences between nonsmokers and smokers in median blood LPS levels (median values, 66.75 and 72.1 pg/mL, respectively; p = 0.55) or plasma concentrations of TNF-alpha (0 vs 0 pg/mL, respectively; p = 0.71), sTNFR I(1,469 vs 1,576 pg/mL, respectively), sTNFR II (2,011 vs 3,110 pg/mL, respectively), or IL-6 (8.8 vs 0 pg/mL, respectively; p = 0.20). CONCLUSIONS: Smoking one pack of cigarettes per day delivers a dose of respirable LPS that is comparable to the levels of LPS associated with adverse health effects in cotton textile workers. Thus, we suggest that the bioactive LPS in cigarette smoke may contribute to the pathogenesis of chronic bronchitis that develops in susceptible cigarette smokers.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10084499&dopt=Abstract

Ann Chir. 1999;53(1):41-7.
[Current indications and results of pulmonary decortication for nontuberculous chronic empyema]

[Article in French]

Magdeleinat P, Icard P, Pouzet B, Fares E, Regnard JF, Levasseur P.

Service de Chirurgie Thoracique et Vasculaire, Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson.

Pulmonary decortication for nontuberculous chronic empyema has become a rare operation, whose indications and results are now rarely analysed and discussed. The authors report a series of 40 consecutive decortications performed over a period of 15 years. PATIENTS: 40 patients treated by pulmonary decortication over 15 years for nontuberculous chronic empyema secondary to pneumonia (27 cases; 2/3 of cases), post-traumatic haemothorax (5 cases), iatrogenic infection after pleural tap (5 cases) and septicaemia (3 cases). Chronic empyema had been present for an average of 6 months (1 to 60 months). Decortication was performed for drainage of persistent pleural suppuration in 22 cases and to release the encysted lung in 18 cases. Decortication, always comprising parietal pleural stripping and visceral decortication, lasted an average of 3 hours (2 to 8 hours), and was accompanied by mean bleeding of 1 litre (of 200 ml to 3.41). RESULTS: 27 patients (67%) had an uneventful postoperative course, with drainage for 6 days and a mean hospital stay of 13 days. 13 patients (33%) developed various complications, mainly re-expansion defects (10 cases), responsible for pyothorax in 4 cases, 3 of which required secondary drainage. One patient died from intestinal obstruction in a context of peritoneal carcinomatosis (operative mortality: 2.5%). 25 patients were reviewed with a mean follow-up of 54 months, with complete pulmonary re-expansion in 23 cases (92%) and a residual pouch in 2 cases. Vital capacity (VC) was evaluated in 8 patients, with a mean improvement of 40% (15 to 66%) in 6 patients, stable VC in one patient, and a 25% reduction in the last patient, a smoker and with chronic bronchitis. CONCLUSION: Pulmonary decortication is an effective, but relatively major operation to treat chronic encysted empyema. Encystment must be prevented by effective drainage of empyema, now facilitated by the possibility of early videothoracoscopic pleural debridement.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10083668&dopt=Abstract

Am J Ind Med. 1999 Apr;35(4):366-74.
Asthma and chemical bronchitis in vanadium plant workers.

Irsigler GB, Visser PJ, Spangenberg PA.

Department of Medicine, University of Pretoria, Republic of South Africa.

BACKGROUND: Whether vanadium induces bronchial hyperresponsiveness and asthma in previously normal subjects is unresolved: the two reported series addressing this question both have shortcomings. OBJECTIVE: To determine the cause of cough and breathlessness in vanadium plant workers after variable periods of exposure. DESIGN: Case series of employees presenting with persistent symptoms over a 24-month study period. PATIENTS AND METHODS: Forty of an estimated 1,440 patients were investigated by 1) blood count and serum IgE, 2) intracutaneous allergen skin tests, 3) spirometry, and 4) bronchoprovocation by histamine inhalation or exercise challenge. Exposure was assessed by measurement of 1) ambient V2O5, NH3 and SO2 over 7 days during the 24-month study period, 2) urine vanadium concentration at time of first presentation. RESULTS: Twelve of 40 subjects had bronchial hyperreactivity (BHR), and these were compared to 12 age-matched companion subjects whose BHR was normal. In 10, BHR was diagnosed by histamine inhalation (PC20 0.25-1.82 mg/ml, nl > 8.0 mg/ml), and in six of these the abnormality was severe (PC20 < 0.5 mg/ml). A further two had BHR by exercise challenge (FEV1, 600 ml/30% and 770 ml/18% pre/post exercise). After removal from exposure, 9 of the 12 subjects returned for follow-up 5 to 23 months later. BHR was worse in one, still present although less severe in five, and was no longer found in one subject. Baseline spirometry measurements were normal in seven subjects and only mildly impaired in the remaining five of the 12 subjects with BHR. CONCLUSION: This study provides strong supporting evidence that inhaled V2O5 induces BHR and asthma in subjects previously free of lung disease; the abnormality may persist for up to 23 months following exposure; routine spirometry will not detect affected subjects.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10086213&dopt=Abstract

Zhonghua Jie He He Hu Xi Za Zhi. 1997 Aug;20(4):228-30.
[A clinicopathological analysis in 46 elderly cases with cor pulmonale]

[Article in Chinese]

Wang X, Ke H, Wang H.

Beijing Hospital.

OBJECTIVE: To recognize the successful experience in diagnosis of cor pulmonale. METHOD: Autopsy records of 46 elderly patients with cor pulmonale were retrospectively analyzed. RESULTS: The average age of cor pulmonale in aged patients is 65. Most patients were died in the age of 70-79. The rates of incorrect diagnosis and mis diagnoss of cor pulmonale in elderly patients were 27% and 6% respectively. Chronic bronchitis and chronic obstructive emphysema were the most commen causes of cor pulmonale in elderly patients with a rate of 84%. The main cause of death were respiratory failure and heart failure with a rate of 53%. The average thickness of right ventricle wall increased with the course of cor pulmonale and the age of death. About 41% cor pumonale cases were combined with coronary heart disease. CONCLUSIONS: These results indicated that the rate of incorrect diagnoses of cor pulmonale in elderly patients was high, and great effort should be made to draw the clinician's attention for diagnose this illness correctly. The best way to reduce the incidence of cor pulmonale is to prevent and treat chronic bronchitis and chronic obstructive emphysema. Prevent and treat respiratory failure and heart failure effectively may decrease the mortality of cor pulmonale in elderly patients.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10072809&dopt=Abstract

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