The Experts below are selected from a list of 234 Experts worldwide ranked by ideXlab platform
Alberto Pesci - One of the best experts on this subject based on the ideXlab platform.
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Clinical and subclinical Alveolitis in connective tissue diseases assessed by bronchoalveolar lavage
Seminars in arthritis and rheumatism, 1997Co-Authors: Paolo Manganelli, Fausto Salaffi, Alberto PesciAbstract:Abstract Subclinical Alveolitis, as assessed by bronchoalveolar lavage (BAL) cell analysis,may be present in the lower respiratory tract of a high proportion of symptom-less patients with connective tissue diseases (CTDs) with normal chest roentgenograms. The distribution of BAL cell types, mainly macrophages, lymphocytes, and polymorphonuclear neutrophils, varies according to type of CTD and to the presence of associated interstitial lung disease (ILD). Neverthe-less, subclinical Alveolitis can be classified into two major groups: lymphocyte and neutrophil Alveolitis. A mixed, lymphocyte and neutrophil Alveolitis may be detected as well. Subclinical Alveolitis, particularly in systemic sclerosis, frequently is associated with abnormalities of lung parenchyma as assessed by computed tomography (CT) scan, supporting the hypothesis that it may be associated with the development of overt ILD. Close follow-up of these patients is needed to better determine whether subclinical Alveolitis precedes ILD and whether early detection of subclinical Alveolitis in CTDs may identify those patients who are at risk for the development of ILD in the future.
Paolo Manganelli - One of the best experts on this subject based on the ideXlab platform.
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Clinical and subclinical Alveolitis in connective tissue diseases assessed by bronchoalveolar lavage
Seminars in arthritis and rheumatism, 1997Co-Authors: Paolo Manganelli, Fausto Salaffi, Alberto PesciAbstract:Abstract Subclinical Alveolitis, as assessed by bronchoalveolar lavage (BAL) cell analysis,may be present in the lower respiratory tract of a high proportion of symptom-less patients with connective tissue diseases (CTDs) with normal chest roentgenograms. The distribution of BAL cell types, mainly macrophages, lymphocytes, and polymorphonuclear neutrophils, varies according to type of CTD and to the presence of associated interstitial lung disease (ILD). Neverthe-less, subclinical Alveolitis can be classified into two major groups: lymphocyte and neutrophil Alveolitis. A mixed, lymphocyte and neutrophil Alveolitis may be detected as well. Subclinical Alveolitis, particularly in systemic sclerosis, frequently is associated with abnormalities of lung parenchyma as assessed by computed tomography (CT) scan, supporting the hypothesis that it may be associated with the development of overt ILD. Close follow-up of these patients is needed to better determine whether subclinical Alveolitis precedes ILD and whether early detection of subclinical Alveolitis in CTDs may identify those patients who are at risk for the development of ILD in the future.
Ashley Woodcock - One of the best experts on this subject based on the ideXlab platform.
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epstein barr virus replication within pulmonary epithelial cells in cryptogenic fibrosing Alveolitis
Thorax, 1995Co-Authors: Jim J Egan, James P Stewart, Philip S Hasleton, John R Arrand, K B Carroll, Ashley WoodcockAbstract:BACKGROUND--Cryptogenic fibrosing Alveolitis (synonymous with idiopathic pulmonary fibrosis) is a clinically heterogeneous condition in which the precipitating factor is unclear. Both environmental and infective factors have been implicated. An association between Epstein-Barr virus (EBV) and cryptogenic fibrosing Alveolitis was suggested over a decade ago by a study based on EBV serology, but the significance of this has been unclear. METHODS--Lung tissue obtained surgically from patients (n = 20) with cryptogenic fibrosing Alveolitis was investigated for evidence of EBV replication and compared with lung tissue from 21 control patients. Fourteen of the 20 patients had received no specific therapy for cryptogenic fibrosing Alveolitis at the time of biopsy. Monoclonal antibodies directed against the EBV viral antigens, EBV viral capsid antigen (VCA) and gp 340/220 antigen, which are expressed during the lytic phase of the EBV life cycle, were studied. RESULTS--Fourteen (70%) of the 20 patients with cryptogenic fibrosing Alveolitis were positive for both EBV VCA and gp 340/220 compared with two (9%) of the 21 controls. In the patients with cryptogenic fibrosing Alveolitis viral replication was localised to pulmonary epithelial cells using epithelial cell markers, and immunohistochemical analysis confirmed the staining to be within type II alveolar cells. CONCLUSIONS--This is the first report of in vivo EBV replication within epithelial cells of the lower respiratory tract in an immunocompetent human host. Furthermore, this suggests that EBV may be an immune trigger or contribute to lung injury in cryptogenic fibrosing Alveolitis, thus offering a potential new avenue of treatment.
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Accuracy of diagnostic coding of hospital admissions for cryptogenic fibrosing Alveolitis.
Thorax, 1991Co-Authors: Ian Johnston, Charles R K Hind, Carol Bleasdale, Ashley WoodcockAbstract:To determine the accuracy of diagnostic coding of cryptogenic fibrosing Alveolitis, the case notes of 166 admissions to four hospitals were reviewed. These consisted of all admissions that had been coded as "idiopathic fibrosing Alveolitis" (ICD code 516.3: 97 admissions) or as "postinflammatory pulmonary fibrosis" (ICD code 515.9: 69 admissions). Of 88 available records of admissions coded as idiopathic fibrosing Alveolitis, 70 (80%) patients had definite cryptogenic fibrosing Alveolitis, and six (7%) possible cryptogenic fibrosing Alveolitis according to predetermined conventional clinical criteria. Only seven (8%) admissions were clearly coded wrongly. Sixty four records were available for patients coded as having postinflammatory pulmonary fibrosis; 16 (25%) of these patients had definite cryptogenic fibrosing Alveolitis, a further 12 (19%) had possible cryptogenic fibrosing Alveolitis or fibrosing Alveolitis with a connective tissue disorder, and the remainder had a very wide range of diagnoses. In this study the idiopathic fibrosing Alveolitis (ICD 516.3) code was relatively reliable, but a substantial proportion of admissions coded under postinflammatory pulmonary fibrosis (ICD 515.9) also had cryptogenic fibrosing Alveolitis and code 515.9 was of little diagnostic value. The data are inadequate for case finding, though in respect of cryptogenic fibrosing Alveolitis may be adequate for planning purposes. There continues to be a need for more medical input into the process of diagnostic coding.
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Accuracy ofdiagnostic coding ofhospital admissions forcryptogenic fibrosing Alveolitis
1991Co-Authors: A Johnston, Charles R K Hind, Ashley WoodcockAbstract:Todetermine theaccuracy ofdiagnostic coding ofcryptogenic fibrosing Alveolitis, thecasenotesof166admissions tofour hospitals werereviewed. Theseconsisted ofalladmissions thathadbeencodedas "idiopathic fibrosing Alveolitis" (ICD code516.3: 97admissions) oras"postinflammatory pulmonary fibrosis" (ICD code515.9: 69admissions). Of 88availablerecordsof admissions codedas idiopathic fibrosing Alveolitis, 70(80%) patients haddefinite cryptogenic fibrosing Alveolitis, and six(7%)possible cryptogenicfibrosing Alveolitis according topredetermined conventional clinical criteria. Onlyseven(8%)admissions wereclearly codedwrongly. Sixtyfour records wereavailable forpatients coded ashavingpostinflammatory pulmonary fibrosis; 16(25%)ofthesepatients had definite cryptogenic fibrosing Alveolitis, a further12(19%)hadpossible cryptogenicfibrosing Alveolitis or fibrosing Alveolitis with a connectivetissue disorder, andtheremainderhada very widerangeofdiagnoses. Inthisstudy the idiopathic fibrosing Alveolitis (ICD516.3) codewasrelatively reliable, buta substantial proportion ofadmissions coded under postinflammatory pulmonary fibrosis (ICD515.9) alsohadcryptogenic fibrosing Alveolitis andcode515.9 wasof little diagnostic value.The dataare inadequate forcasefinding, thoughin respect ofcryptogenic fibrosing Alveolitis may beadequate forplanning purposes. Therecontinues tobea needformore medicalinputintothe processof diagnostic coding.
R. M. Du Bois - One of the best experts on this subject based on the ideXlab platform.
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Neutrophil activation in fibrosing Alveolitis: a comparison of lone cryptogenic fibrosing Alveolitis and systemic sclerosis
The European respiratory journal, 1996Co-Authors: Jeremy Cailes, Christine O'connor, Panagiotis Pantelidis, A.m. Southcott, Muiris X. Fitzgerald, Christopher M. Black, R. M. Du BoisAbstract:Fibrosing Alveolitis complicating systemic sclerosis (FASSc) carries a better prognosis than lone cryptogenic fibrosing Alveolitis (CFA). We wanted to determine whether this improved prognosis is associated with differential neutrophil migration and activation in the lower respiratory tract. We therefore compared bronchoalveolar lavage (BAL) neutrophil numbers and levels of neutrophil-derived enzymes in FASSc, CFA and normal individuals. Bronchoalveolar lavage was performed on 45 subjects (FASSc n = 20; CFA n = 15; normals n = 10); cell counts and levels of neutrophil-derived enzymes, myeloperoxidase, elastase (total elastase and elastase/alpha 1 antitrypsin complexes), collagenase and lactoferrin were measured. Lung function testing was performed in subjects with fibrosing Alveolitis. Significant differences in the levels of collagenase, myeloperoxidase and elastase/ alpha 1-antitrypsin complexes were present in the BAL fluid from the three groups. Patients with CFA had significantly higher neutrophil percentages and levels of collagenase and myeloperoxidase than those with FASSc. Disease extent, as judged by lung volumes and gas transfer, was comparable in the CFA and FASSc groups. Forced vital capacity (% predicted) was significantly lower in patients with evidence of increased neutrophil enzyme release than those without. We conclude that: 1) increased neutrophil migration to the lung is accompanied by release both of primary and secondary granule enzymes in cryptogenic fibrosing Alveolitis; and 2) the lower amounts of neutrophil products in fibrosing Alveolitis complicating systemic sclerosis may account for the improved prognosis, even when disease is as extensive as in cryptogenic fibrosing Alveolitis.
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Accuracy of the typical computed tomographic appearances of fibrosing Alveolitis.
Thorax, 1993Co-Authors: K. T. Tung, R. M. Du Bois, Au Wells, Michael B. Rubens, J. M. E. Kirk, David M. HansellAbstract:BACKGROUND--Open lung biopsy is often performed to confirm the diagnosis in patients with suspected fibrosing Alveolitis. The superior sensitivity and specificity of high resolution computed tomography (CT) over chest radiography in various diffuse lung diseases suggest that the characteristic appearance of fibrosing Alveolitis on high resolution CT might render biopsy confirmation unnecessary. METHODS--The chest radiographs and high resolution CT scans of 86 patients (41 with fibrosing Alveolitis and 45 with various other diffuse lung diseases) were examined individually and independently by two observers. No clinical information was given and the observers gave a level of confidence when the diagnosis was thought to be fibrosing Alveolitis. RESULTS--The observers correctly and confidently discriminated between fibrosing Alveolitis and other diffuse lung diseases on high resolution CT with an accuracy of 88% and on chest radiography with an accuracy of 76%. The false negative rate for fibrosing Alveolitis diminished from 29% on chest radiography to 11% on high resolution CT. The false positive rate on chest radiography was 19% and on high resolution CT 13%; the false positive diagnoses on CT were the result of a few conditions (extrinsic allergic Alveolitis, sarcoidosis, cryptogenic organising pneumonia, and pulmonary eosinophilia) which mimicked some of the CT features of fibrosing Alveolitis. The superficial similarity of the CT patterns of these conditions are discussed. CONCLUSIONS--High resolution CT is superior to chest radiography in establishing the diagnosis of fibrosing Alveolitis and the typical CT appearances are virtually pathognomonic. The diagnostic advantages of CT over chest radiography should further reduce the need for open lung biopsy in this condition.
John Britton - One of the best experts on this subject based on the ideXlab platform.
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Risk of cryptogenic fibrosing Alveolitis in metal workers.
Lancet (London England), 2000Co-Authors: Richard Hubbard, Ian Johnston, Andrea Venn, Marie Cooper, Sarah Lewis, Marilyn Antoniak, Sayeed Khan, John BrittonAbstract:Summary We report increased proportional mortality from cryptogenic fibrosing Alveolitis in the workforce of a major UK engineering company. Measures of mental exposure from unbiased historical occupational records showed that among employees who have worked with metal, the risk of death from or with cryptogenic fibrosing Alveolitis increased in relation to the duration of metal-working.
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lung cancer and cryptogenic fibrosing Alveolitis a population based cohort study
American Journal of Respiratory and Critical Care Medicine, 2000Co-Authors: Richard Hubbard, Andrea Venn, Sarah Lewis, John BrittonAbstract:Cryptogenic fibrosing Alveolitis has been reported to be associated with an increased risk of lung cancer. However, it has recently become apparent that cigarette smoking may be a risk factor for cryptogenic fibrosing Alveolitis as well as for lung cancer, and so may confound the association between these conditions. We have therefore estimated the independent increase in lung cancer incidence in patients with cryptogenic fibrosing Alveolitis compared with the general population in a population-based cohort study involving 890 subjects with cryptogenic fibrosing Alveolitis and 5, 884 control subjects drawn from the United Kingdom General Practice Research Database. The incidence of lung cancer was markedly increased among patients with cryptogenic fibrosing Alveolitis (rate ratio [RR] 7.31, 95% confidence interval [95% CI] 4.47 to 11.93, p < 0.001), and adjustment for previous smoking history had little effect on this odds ratio (adjusted RR: 8.25, 95% CI 4.70 to 11.48, p < 0.001). This increase in lung cancer incidence remained when the analysis was restricted to current smokers (RR 7.36, 95% CI 1.54 to 35.19, p = 0.012). This study provides clear evidence that the incidence of lung cancer is increased in patients with cryptogenic fibrosing Alveolitis, and that this effect is independent of the effect of cigarette smoking.
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exposure to commonly prescribed drugs and the etiology of cryptogenic fibrosing Alveolitis a case control study
American Journal of Respiratory and Critical Care Medicine, 1998Co-Authors: Richard Hubbard, Ian Johnston, Andrea Venn, Christopher Smith, Marie Cooper, John BrittonAbstract:Cryptogenic fibrosing Alveolitis is an interstitial lung disease of unknown etiology. Since pulmonary fibrosis is a recognized, if rare, complication of certain drug exposures, including antidepressants, betablockers, antibiotics, anticonvulsants, and nonsteroidal antiinflammatory drugs (NSAIDs), we tested the hypothesis that exposure to these drugs might contribute to the etiology of cryptogenic fibrosing Alveolitis. Lifetime drug exposure data were collected from general practitioner records for 141 cases of cryptogenic fibrosing Alveolitis and 246 age-, sex-, and community-matched control subjects from the Trent region of England. Additional data on lifetime smoking habits were obtained by postal questionnaire. The odds of disease in relation to ever exposure to antidepressants, betablockers, antibiotics, anticonvulsants, and NSAIDs were calculated by conditional logistic regression. For drug groups significantly associated with cryptogenic fibrosing Alveolitis, subset analyses were performed to investigate the effects of individual drugs. Cryptogenic fibrosing Alveolitis was associated with exposure to antidepressants (odds ratio [OR] 1.79 [95% CI 1.09-2.95], p = 0.022) and specifically to imipramine (OR 4.79 [1.50-15.3], p = 0.01), dothiepin (OR 2.37 [0.99-5.69], p = 0.05), and mianserin (OR 3.27 [1.11-9.61], p = 0.03). The magnitude of the overall effect of antidepressants was not changed by excluding all drug exposures within the 5 yr preceding the diagnosis of cryptogenic fibrosing Alveolitis (OR 1.62 [0.94-2.77], p = 0.081), nor were the strong individual effects of imipramine (OR 5.72 [1.54-21.2], p = 0.009) and dothiepin (OR 5.58 [1.12-27.8], p = 0.036). These estimates were not appreciably affected by controlling for smoking history. The attributable risk for antidepressant exposure was in the region of 9-14%. No significant association was noted between cryptogenic fibrosing Alveolitis and the four other drug groups in the primary hypothesis. The results of this study suggest that some antidepressant drugs can cause cryptogenic fibrosing Alveolitis.