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Biomedical subjects

D B Ettensohn

Publications and source records attributed to D B Ettensohn.

At least 19 recordsLinked to original sources
PubMed1990

Adult respiratory distress syndrome after limited resection of adenocarcinoma of the lung.

Two cases of the adult respiratory distress syndrome developed after limited resection for lung carcinoma. No other known precipitants were evident. The adult respiratory distress syndrome is a clinical expression of acute lung injury that may arise from various insults and include air and blood borne factors. Tumour related blood borne factors may have contributed to lung injury in these cases.

Adenocarcinoma↗
PubMed1990

Alveolar hemorrhage with epithelioid hemangioendothelioma. A previously unreported manifestation of a rare tumor.

Epithelial hemangioendothelioma (EH), originally termed intravascular sclerosing bronchioloalveolar tumor (IVBAT), is a rare pulmonary vascular neoplasm usually associated with an indolent but slowly progressive clinical course. We describe a patient with EH who presented with alveolar hemorrhage and died within 8 wk. This report extends the clinical spectrum of epithelial hemangioendothelioma to include this aggressive form. EH should be considered in the differential diagnosis of alveolar hemorrhage syndrome.

Aged↗
PubMed1989

Alveolar hemorrhage in Wegener's granulomatosis.

The authors describe massive, fatal alveolar hemorrhage in an 82-year-old woman in whom a diagnosis of Wegener's granulomatosis was made at postmortem examination. A literature review revealed a total of 18 case reports of this entity that were described in sufficient detail to permit abstraction of clinical characteristics. When compared with a large series of patients with more "typical" Wegener's granulomatosis, patients with alveolar hemorrhage had more evidence of systemic vasculitis and glomerulitis and less evidence of upper airway disease. Alveolar hemorrhage was associated with greater than 50% mortality, reflecting in part, the fulminant nature of this complication of Wegener's granulomatosis. All survivors had been treated with cytotoxic agents; those who died had either no specific therapy or were treated either with corticosteroids alone or died before cytotoxic therapy could be expected to be effective. Wegener's granulomatosis should be in the differential diagnosis for patients who present with alveolar hemorrhage with or without renal failure. An aggressive diagnostic approach and the earliest possible administration of cytotoxic drugs in combination with corticosteroids offer the best chance of survival in this fulminant condition.

Aged↗
PubMed1989

Relapse of Pneumocystis carinii pneumonia in the upper lobes during aerosol pentamidine prophylaxis.

Pneumocystis carinii pneumonia was diagnosed by bronchoalveolar lavage of the upper lobes in a patient with the acquired immunodeficiency syndrome (AIDS) receiving aerosol pentamidine prophylaxis. Serendipitous availability of a normal premorbid lung gallium scan indicated that pneumocystosis had developed during aerosol pentamidine prophylaxis; at the time of presentation a repeat gallium scan indicated disease limited to the upper lobes. The relation of this unusual form of isolated upper lobe Pneumocystis carinii pneumonia to aerosol pentamidine prophylaxis warrants further investigation.

Administration, Inhalation↗
PubMed1989

The role of human alveolar macrophages in the allogeneic and autologous mixed leucocyte reactions.

Human alveolar macrophages (AM) are deficient in their ability to promote antigen-stimulated lymphocyte proliferation when compared to in-vitro-aged blood derived macrophages (BM). The mechanisms behind the unique accessory cell function of human AM are unknown. The current paradigm for accessory cell function requires antigen presentation in the context of gene products of the HLA-DR locus of the major histocompatibility complex (Class II, DR antigens) and secretion of non-specific second signal (e.g. interleukin 1). While both AM and in-vitro-aged BM have limited ability to secrete interleukin 1 (IL-1), more than 90% of both cell types express DR antigens. However, only BM consistently promote antigen-stimulated lymphocyte proliferation. Addition of IL-1 does not restore accessory cell function of human AM for antigen stimulation. It is possible that DR antigen expression and/or function of AM may be more contributory for their accessory cell function. The mixed leucocyte reaction (MLR) and autologous mixed leucocyte reactions (AMLR) in which DR epitopes stimulate proliferation of allogeneic and autologous T cells, respectively, are useful in vitro assays for assessment of DR-restricted macrophage-lymphocyte interactions. In the current studies we demonstrate that AM are usually equivalent to autologous in-vitro-aged BM in their ability to stimulate an MLR, but are consistently deficient relative to such BM in their ability to stimulate an AMLR. Experiments in which the two cells were co-cultured indicate that AM-mediated suppression does not account for the limited ability of AM to stimulate an AMLR. The deficiency of AM to act as accessory cells for antigen-stimulated lymphocyte proliferation may relate to their relative inability to stimulate autoreactive T cells and be attributable to differences in DR antigen expression and/or function.

Adult↗
PubMed1988

Bronchoalveolar lavage in talc induced lung disease.

A 65 year old woman with a history of occupational talc inhalation presented with hypoxaemia, cough, and dyspnoea with a normal chest radiograph. Bronchoalveolar lavage showed considerable lymphocytosis, with a predominance of T8+ T lymphocytes, and open lung biopsy showed peribronchiolar granulomas containing talc crystals. Corticosteroid treatment resulted in dramatic improvement. Bronchoalveolar lavage may aid in the diagnosis of talc related lung injury.

Aged↗
PubMed1988

Human alveolar macrophage suppression of lymphocyte proliferation. Accessory characteristics for the generation and functional expression of con A-induced suppressor cells.

Human alveolar macrophages (AM) provide less accessory support for mitogen- and antigen-stimulated lymphocyte proliferation than do autologous blood-derived macrophages (BM). This is at least in part due to suppression mediated by AM, but the mechanism of such suppression is not understood. To determine whether AM-mediated suppression is related to AM interaction with suppressor lymphocytes (Ts), we examined the accessory cell function of both AM and BM for the generation and functional expression of Ts induced by concanavalin A (Con A). The data indicate that human AM are equivalent to BM for the generation of Con A-induced Ts, but AM mediate less suppression of Con A-induced Ts, once generated, than do BM. Addition of indomethacin did not increase lymphocyte proliferation when AM served as accessory cells. Supernatant fluids of Con A-exposed AM promoted greater proliferation of human T-lymphocytes and mouse thymocytes than did supernatant fluids from Con A-exposed BM. Interleukin-1 inhibitor activity was not detected in the supernatant fluids. These observations make it unlikely that soluble factors alone account for AM-mediated suppression. Thus, at least for the Con A-induced Ts system, AM do not mediate suppression either via better generation or greater functional expression of suppressor cells relative to BM. The paradoxically greater proliferation of lymphocytes stimulated by the supernatant fluids of Con A-exposed AM raises the possibility that suppression of Con A-stimulated lymphocyte proliferation observed when AM serve as the accessory cells in primary culture may be related to AM secretion of a molecule with IL-1-like activity.

Adult↗
PubMed1988

Lymphocytic bronchiolitis associated with HIV infection.

Patients with the acquired immune deficiency syndrome (AIDS) frequently develop interstitial lung disease. This is due most commonly to opportunistic infections, but malignancy and lymphocytic interstitial pneumonitis have also been associated with the syndrome. In contrast, there has been little reported about airways disease in patients with HIV infection. We describe a patient with AIDS-related complex who presented with symptoms and radiographic evidence of micronodular interstitial lung disease. Transbronchial biopsy revealed a lymphocytic bronchiolitis but no evidence of interstitial lung disease and a marked T-suppressor lymphocytosis was found on analysis of the bronchoalveolar lavage (BAL) specimen. Routine fungal, viral and bacterial cultures did not yield an etiologic agent. This case raises the possibility that lymphocytic bronchiolitis may represent another pulmonary manifestation of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Bronchoalveolar lavage in the normal volunteer subject. I. Technical aspects and intersubject variability.

To investigate subject-to-subject variability in commonly used parameters from bronchoalveolar lavage (BAL), we analyzed the results of BAL from 78 consecutive normal volunteer subjects. The BAL was performed using three, 40 ml aliquots of normal saline solution, in a lingular subsegment. The same diameter bronchoscope (4.8 mm) was used and BAL was performed and analyzed identically in all subjects. While the percentage of lavageate returned was relatively consistent from subject to subject (63.4 +/- 10.8 percent, mean +/- SD), there was marked variability in the number of cells obtained (7.3 +/- 3.9 X 10(6)). While low returns were generally associated with a diminished cell recovery, in the range of normal percentage returned, there was no correlation with the number recovered. There was no correlation of cell number or percent lavageate returned with gender, height, or any lung volume (as determined on pulmonary function tests). There was relatively little variability in differential analysis of recovered cells. The BAL was well tolerated by all subjects; the chest roentgenogram was found to be of little utility in screening normal subjects, but pulmonary function testing detected obstructive lung disease in three potential subjects leading to their disqualification as "normal." Our experience confirms the safety of bronchoalveolar lavage in normal volunteer subjects. We report the BAL results that can be expected for research or clinical comparison using a protocol described in detail. The variability of cell numbers from BAL, even under these controlled conditions, precludes the routine use of this measurement from BAL performed for clinical purposes.

Adult↗
PubMed1988

Bronchoalveolar lavage in the normal volunteer subject. 2. Safety and results of repeated BAL, and use in the assessment of intrasubject variability.

To investigate the safety of repeated bronchoalveolar lavage (BAL) and the variability of commonly measured parameters from BAL to BAL in the same subject, we performed a total of 59 BALs in 16 normal volunteer subjects. The BAL was performed with 120 ml (three aliquots of 40 ml) of room temperature, normal saline in a lingular subsegment. Four subjects had five BAL, three had four BAL, and nine had three BAL performed at minimal intervals of six weeks. The BAL analysis included percentage of lavageate returned, cell number, and percentage of alveolar macrophages, lymphocytes, neutrophils and eosinophils. Relatively similar percentages of lavageate were returned on each lavage. There was considerable variability in the cell numbers obtained both within and between subjects, although some subjects had consistently high, low, or normal cell numbers returned from each lavage. Cell differential was the most consistent parameter on repeated BAL analyses, but isolated "abnormal" elevations in the percentage of one or another cell type were occasionally noted. These were unrelated to either the number or relative sequence of the BALs. Pulmonary function tests performed both before and after the repeated BAL showed no significant change and participants noted no subjective deterioration in pulmonary function. This study supports the safety of repeated BALs in the normal subject, but the variability in cell numbers obtained and isolated, "abnormal" elevations of inflammatory cells occasionally noted in this normal population indicate that BAL parameters in patients need to be interpreted with extreme caution.

Adult↗
PubMed1988

Unilateral absence of the diaphragm in an asymptomatic adult.

An asymptomatic 22-year-old man was evaluated for a persistent left lower lobe infiltrate. Barium enema and upper gastrointestinal series revealed colon and small bowel freely mobile in the left thorax. CT confirmed absence of the left hemidiaphragm. This is the first reported case of total absence of a hemidiaphragm in an adult, and extends the clinical spectrum of diaphragmatic defects where strangulation of hernia contents may occur , the asymptomatic presentation of complete absence of the hemidiaphragm with the unimpeded movement of abdominal contents suggests that no treatment is necessary.

Adult↗
PubMed1987

Gold lung: recent developments in pathogenesis, diagnosis, and therapy.

Gold lung is a hypersensitivity pneumonitis to gold-containing compounds. It can be distinguished from rheumatoid lung by its subacute or acute onset, diffuse interstitial and/or alveolar filling pattern on chest roentgenogram, presence of lymphocytes on BAL with an inverse helper/suppressor ratio, and response to withdrawal of gold and/or corticosteroid therapy. Other in vitro assays of gold hypersensitivity using peripheral blood lymphocytes are only sporadically positive and, therefore, of limited value in making the diagnosis. Physicians prescribing organic gold compounds should elicit pulmonary complaints throughout the duration of therapy. When patients receiving gold therapy present with signs and symptoms consistent with an acute or subacute hypersensitivity pneumonitis, the gold therapy should be withheld and a diagnostic workup initiated.

Aged↗
PubMed1986

Human alveolar macrophage regulation of lymphocyte proliferation.

Human alveolar macrophages obtained by bronchoalveolar lavage have different accessory cell characteristics than do autologous, peripheral-blood-derived macrophages for the support of lymphocyte proliferative responses. To further investigate these differences, we performed mixing experiments in which variable numbers of the 2 macrophages were cocultured and assayed for support of mitogen-(phytohemagglutinin; PHA) and antigen-(streptokinase-streptodornase; SK-SD) stimulated proliferation of purified autologous lymphocytes. Alveolar macrophages promoted greater lymphocyte proliferation, in proportion to their added number in coculture with peripheral-blood-derived macrophages, when using a suboptimal concentration of PHA. In contrast, even small numbers of alveolar macrophages suppressed lymphocyte proliferation supported by peripheral-blood-derived macrophages when using the optimal concentration of PHA or the antigen SK-SD. The data indicated that diminished support exhibited by alveolar macrophages for optimal mitogen-stimulated or antigen-stimulated lymphocyte responses was due to active suppression by the cells, rather than to deficient or defective accessory cell function. Thus, alveolar macrophages have regulatory effects on lymphocyte proliferation that are dependent on type and concentration of mitogenic stimulation. Such regulation may relate to alveolar macrophage function in vivo, providing appropriate response yet limiting inflammation in the lung.

Adult↗
PubMed1985

Endobronchial metastases from carcinoma of the breast.

We report the case histories of four patients with endobronchial metastases from breast cancer, two of whom died of resultant respiratory insufficiency. To aid in earlier diagnosis and thus permit more rapid application of specific therapy, we characterized the epidemiology and presenting symptoms of these patients and 38 additional patients with endobronchial metastases from breast carcinoma that have been reported in the literature. The average age at presentation with endobronchial metastases was 55, and the average time from diagnosis of the breast primary lesion to the endobronchial metastasis was 77 months. Cough occurred in 71% of patients; wheezing and hemoptysis occurred in 25%. Segmental atelectasis occurred in 57% on chest roentgenogram. Average survival of patients from the time of diagnosis of endobronchial metastasis was 21 months; median survival was 19 months.

Adenocarcinoma↗
PubMed1985

Bronchoalveolar lavage in lymphangitic spread of adenocarcinoma to the lung.

We report the results of bronchoalveolar lavage in a patient who had pulmonary lymphangitic spread of adenocarcinoma from an unknown primary. The lavage specimen was remarkable for a large increase in the number of lymphocytes. This observation extends the differential diagnosis of a lymphocyte-predominant lavage specimen. The recovery of large numbers of lymphocytes associated with malignancy in this case suggests that bronchoalveolar lavage may also be useful to study aspects of the immune response to interstitial lymphangitic spread of malignancy to the lung.

Adenocarcinoma↗
PubMed1984

Influenza virus infection of human alveolar and blood-derived macrophages: differences in accessory cell function and interferon production.

Influenza virus infection in vitro depresses accessory cell function of human peripheral blood-derived macrophages (PBM phi) for lymphocyte proliferative responses, but effects on such functions of alveolar macrophages (AlvM phi) have not been described. AlvM phi were obtained by bronchoalveolar lavage from normal young volunteers, and the effects of influenza virus infection of AlvM phi and autologous PBM phi were compared by measuring the accessory support provided by these cells for phytohemagglutinin-induced proliferation of purified autologous lymphocytes. Accessory cell function of AlvM phi was not altered by viral infection; in contrast, this function was significantly depressed with autologous virus-infected PBM phi. Virus-infected PBM phi produced greater amounts of interferon than did autologous AlvM phi. However, synthesis of interferon or prostaglandins by virus-infected cells could not account, per se, for depression of lymphocyte responses in the presence of PBM phi. These studies detail functional heterogeneity of autologous PBM phi and AlvM phi in response to a common respiratory-tract pathogen, influenza virus.

Adult↗
PubMed1984

Influenza virus infection of human alveolar and peripheral blood-derived macrophages. Production of factors that alter fibroblast proliferation.

Influenza virus infection of the lung has been shown, in animal models as well as in isolated human case reports, to cause a long-term alveolitis characterized by increased numbers of free lung macrophages. Recruitment of peripheral blood monocytes into the interstitial spaces, with subsequent maturation into tissue macrophages, accounts for most of the observed increase in cell numbers. The current studies examined the release of soluble factors by lavage-derived alveolar macrophages from healthy volunteers, and by peripheral blood-derived macrophages from the same subjects. Cell-free supernatant fluids generated by the macrophages after in vitro exposure or sham exposure to influenza virus were tested for effects on human fibroblast proliferation. The data indicated that autologous human alveolar macrophages and peripheral blood-derived macrophages both produce fibroblast-stimulating factor(s) in response to in vitro infection. The data suggest that macrophage release of fibroblast-stimulating factor(s) may play a role in the development of end-stage fibrotic lung disease occasionally seen as a sequela of influenza pneumonia.

Adult↗