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Biomedical subjects

E Begliomini

Publications and source records attributed to E Begliomini.

16 recordsLinked to original sources
PubMed2001

Relationship between extent of pulmonary emphysema by high-resolution computed tomography and lung elastic recoil in patients with chronic obstructive pulmonary disease.

We investigated the relationship between the extent of pulmonary emphysema, assessed by quantitative high-resolution computed tomography (HRCT), and lung mechanics in 24 patients with chronic obstructive pulmonary disease (COPD). The extent of emphysema was quantified as the relative lung area with CT numbers < -950 Hounsfield Units (HU). Patients with COPD had severe airflow obstruction (FEV(1) 35 +/- 15% pred) and severe reduction of CO diffusion constant (DCO/VA 37 +/- 19% pred). Maximal static elastic recoil pressure (Pst(max)) averaged 54 +/- 24% predicted, and the exponential constant K of pressure-volume curves was 258 +/- 116% predicted. Relative lung area with CT numbers < -950 HU averaged 21 +/- 11% (range 1 to 38%). It showed a highly significant negative correlation with DCO/VA (r = -0.84, p < 0.0001), a weak correlation with FEV(1)% predicted, and no correlation with either Pst(max) or constant K. A significant relationship was found between the natural logarithm of K and the full width at half maximum of the frequency distribution of CT numbers, taken as an index of the heterogeneity of lung density (r = 0.68, p < 0.0005). We conclude that currently used methods of assessing the extent of emphysema by HRCT closely reflect the reduction of CO diffusion constant, but cannot predict the elastic properties of the lung tissue.

Aged↗
PubMed1998

Single breath diffusing capacity for carbon monoxide: effects of adjustment for inspired volume dead space, carbon dioxide, hemoglobin and carboxyhemoglobin.

In order to assess the additive effects of taking into account dead space volume (VD), carbon dioxide, hemoglobin (Hb) and carboxyhemoglobin on computation of single breath carbon monoxide diffusing capacity (DLCOsb), we sequentially applied all the corrections recommended by the 1987 American Thoracic Society (ATS) document on DLCOsb standardization. We used data from 739 men (333 nonsmokers and 406 current smokers) and 475 women (403 nonsmokers and 72 current smokers) who underwent measurement of DLCOsb in the decade 1985-1994 at the Lung Function Laboratory of our institute. With respect to the unadjusted DLCOsb value, significant small differences were found for all the corrected formulas, ranging from -0.18 to 1.48 ml/min/mm Hg in men and from -0.24 to 1.57 ml/min/mm Hg in women. After computing the percent change of DLCOsb [(unadjusted-adjusted value) x 100/unadjusted value], we observed that the correction for VD caused an underestimation of DLCOsb of about 5.8% in men and 7.7% in women. However, when all the corrections were considered, these figures decreased to about 0.9% in males and 2.9% in females. Regarding specifically the correction for Hb, the adjusted value was slightly lower in men, while it was some-what higher in women, with respect to the unadjusted DLCOsb. In conclusion, the corrections suggested by ATS in the computation of DLCOsb, when considered altogether, seem to account for a limited proportion of test variability in usual clinical conditions, especially in males.

Adolescent↗
PubMed1997

Interstitial lung fibrosis and rheumatic disorders in patients with hepatitis C virus infection.

A possible aetiopathogenetic role of hepatitis C virus (HCV) has been reported in various immune-mediated disorders, such as mixed cryoglobulinaemia, which may be complicated by interstitial lung involvement; moreover, different viruses, including HCV, have been correlated with idiopathic pulmonary fibrosis. Here, a cohort of eight HCV-positive patients (M/F = 4/4, mean age 61 +/- 8 S.D. yr) with interstitial lung fibrosis and a variable number of rheumatic disorders are described. Interstitial lung involvement appeared medially 4.5 +/- 3.2 S.D. yr after the clinical onset of chronic hepatitis. During the clinical follow-up, some rheumatic symptoms were also recorded: articular involvement (four patients): mild sicca syndrome (one patient); severe polymyositis and cranial neuropathy (one patient); serum cryoglobulins and/or autoantibodies (eight patients). In all patients, a moderate (four patients) or severe (four patients) lung fibrosis was evaluated by means of high-resolution computed tomography. The presence of parenchymal radiotracer uptake on 67Ga scan (7/7 patients) and increased percentages of neutrophils (4/4 patients) and lymphocytes (2/4) at bronchoalveolar lavage suggested an active lung involvement. Different degrees of reduction of single breath diffusing capacity for carbon monoxide (DLco) (mean value 57.6 +/- 15%, range 37-80) were observed in all cases, while spirometric abnormalities, consistent with a global restrictive pattern, were less frequently found. In all cases, anti-HCV antibodies and HCV viraemia were demonstrated: viral genome was also detected in peripheral lymphocytes from 4/4 subjects and in one case in lung biopsy specimens. A desquamative interstitial pneumonia pattern was demonstrated in two cases by lung biopsy. The present work supports the hypothesis that HCV chronic infection could represent a trigger factor for interstitial lung fibrosis and various rheumatic disorders.

Aged↗
PubMed1995

Chest radiography and high resolution computed tomography in the evaluation of workers exposed to silica dust: relation with functional findings.

OBJECTIVES: To compare the usefulness of high resolution computed tomography (HRCT) with chest radiography (CR) in the diagnosis and assessment of severity of silicosis. METHODS: 27 workers exposed to silica underwent CR, HRCT, and pulmonary function tests. Two experienced readers independently evaluated CR by International Labour Office classification, and grouped the results into four categories. HRCT categories of nodule profusion and the extent of emphysema were graded on a four point scale; in 20 subjects the percentage distribution of lung densities were measured by HRCT. RESULTS: Concordance between readers was higher for HRCT than for CR (K statistic = 0.49 and 0.29 respectively). There was poor concordance between CR and HRCT in the early stage of silicosis. No significant difference in pulmonary function tests was found among different CR categories, but forced expiratory volume in one second (FEV1), maximal expiratory flow at 50% and 75% of FVC (MEF50, MEF75), and diffusion capacity significantly decreased with increasing HRCT categories. Subjects with simple silicosis detected by HRCT had a lower FEV1 than subjects without silicosis, whereas subjects with conglomerated silicosis showed higher residual volume and functional residual capacity than subjects with simple silicosis. These relations were not affected by smoking or symptoms of chronic bronchitis. Different grades of emphysema detected by HRCT were significantly different in diffusion capacity. Only the HRCTs of the lowest and the highest categories of profusion of parenchymal opacities were significantly different in their distribution of density classes. CONCLUSION: HRCT is more reproducible and accurate than CR, as suggested by the higher agreement between readers and the better correlation with pulmonary function tests, irrespective of smoking and chronic bronchitis; however, these data do not support the hypothesis that HRCT is more sensitive than CR in the early detection of silicosis.

Adult↗
PubMed1995

Mechanisms of hypoxemia and hypocapnia in pulmonary embolism.

Mechanisms of hypoxemia and hypocapnia in pulmonary embolism (PE) are incompletely understood. We studied 10 patients at diagnosis (D) and five of these again after 10 to 14 d of heparin treatment (T). Patients had right heart catheterization, assessment of ventilation-perfusion ratio (VA/Q) distribution by inert gas, radioisotopic perfusion and ventilation scans, and angiography. At D, two-thirds of the pulmonary circulation was obstructed, patients were hypoxemic (PaO2 = 63.0 +/- 11.7 mm Hg) and hypocapnic (PaCO2 = 30.0 +/- 4.1 mm Hg), mixed venous oxygen pressure (PvO2) was reduced (30.9 +/- 3.9 mm Hg), minute ventilation (VE) markedly increased (14.1 +/- 5.1 L/min), and cardiac output measured by applying the Fick principle to arteriovenous oxygen content difference (QT) slightly low (4.7 +/- 1.7 L/min). Hypoxemia was mainly explained by VA/Q inequality, reduced PvO2 also contributed. Hypocapnia was the result of hyperventilation. VA/Q inequality was characterized by shift of VA and Q distribution mean to regions with higher VA/Q ratio through a fraction of blood flow (19.0 +/- 24.3% of cardiac output) went to lung units with low VA/Q ratio. Log SDQ and log SDvA were increased. Shunt, diffusion limitation, or true alveolar dead space occurred in occasional patients but were generally insignificant. Regional ventilation and perfusion maps indicated that in the unperfused lung segments, ventilation was reduced. Furthermore, they disclosed overperfused lung segments. At T, hypoxemia and hypocapnia improved considerably. However, temporal imbalances in recovery between regional ventilation and perfusion occurred with the former normalizing sooner. However, perfusion recovered sooner than ventilation in some regions.

Cardiac Catheterization↗
PubMed1993

The assessment of respiratory function in a patient with dyspnoea and severe hypoxaemia.

In the investigation of dyspnoea and severe hypoxaemia the clinical relevance of multiple diagnostic techniques was studied. The patient was sequentially studied utilizing several techniques. The degree of lung impairment by spirometry, diffusing capacity for carbon monoxide, haemodynamics, pulmonary gas exchange, ventilation-perfusion relationships assessed by the multiple inert gases elimination techniques, ventilation and perfusion lung scans, gallium 67 scintigraphy, bronchoalveolar lavage and high resolution computerized tomography, twice over a period of 12 months during recovery under treatment. A marked impairment of pulmonary gas exchange was first explained by diffusion impairment and ventilation-perfusion mismatch. The multiple inert gas elimination technique allowed determination of the cause of hypoxaemia by ventilation-perfusion inequality. A pathological correlate of the ventilation-perfusion inequality was the appearance of honeycomb lungs detected by high resolution computed tomograph and active alveolitis by bronchoalveolar lavage. All results were consistent with a diagnosis of fibrosing alveolitis. The patient was evaluated again during treatment. Some functional improvement occurred despite persistence of the same pathological findings. In conclusion, this study demonstrates the value of information derived from different tests. Physiological correlations complemented by pathological observations expand understanding of the pathogenesis of disease. These procedures contribute to understanding mechanisms responsible for functional impairment.

Bronchoalveolar Lavage Fluid↗
PubMed1992

Sarcoidosis in Tuscany. A preliminary report.

A retrospective study was carried out by a computerized questionnaire in a sample of 109 sarcoidosis patients (43 men, 66 women) diagnosed between 1977 and 1990 in Pisa. 94% of the patients were resident in Tuscany. The onset of disease was earlier in the men than in the women; in 73% of the patients the symptoms were first noticed between February and July with two incidence peaks; 71% of them had never smoked; 10% of patients were symptom-free and the disease was discovered by chance; the other patients (90%) underwent chest X-ray because of joint symptoms (35%), erythema nodosum (34%), cough (28%), dyspnoea (27%), and fever (24%) which was often associated with other symptoms. Symptoms from the respiratory tract was present in 66 patients (61%); 58% of patients were resident in rural areas; the level of education was limited to primary school in 50% of the patients; as to the prevailing working positions, 27% were clerical workers, 24% manual workers, and 26% housewives.

Adult↗
PubMed1989

Lung function in essential mixed cryoglobulinemia: a short-term follow-up.

Lung involvement in essential mixed cryoglobulinemia (EMC) has been recently described. In order to assess whether patients with EMC experience an accelerated deterioration of lung function, nineteen patients (17 females, 2 males; 49.6 +/- 6.6 years) underwent a short-term follow-up of lung function, chest X-ray and serologic investigations. Reduction of forced expiratory flows and presence of roentgenologic signs of interstitial involvement were confirmed in the baseline evaluation. In addition, a decrease of diffusing capacity was shown. After a mean interval of 15 months, no significant change in lung function was found, with the exception of decrease in maximal expiratory flow at 50% of forced vital capacity, total lung capacity, functional residual capacity, coefficient of transfer of CO. A slight decrease of hemolitic complement (CH50) and of complement fraction (C3) was also observed. This study suggests that patients with EMC tend to have an involvement of pulmonary interstitial space, possibly related to immune complex deposition, but they do not show a severe decline of lung function. Periodical assessment of lung function and chest X-ray is, however, worthwhile.

Adult↗
PubMed1988

Ventilation-perfusion heterogeneity and gas exchange variables in acute pulmonary embolism evaluated by two different computerized techniques.

The mechanisms by which the disturbances of gas exchange develop in human pulmonary embolism are unknown. We investigated whether the inequality of ventilation-perfusion ratio is associated with the abnormalities of pulmonary gas exchange as evaluated by two different computerized techniques. We measured the alveolar to arterial gradients of oxygen and carbon dioxide by means of a computer based system with a mass spectrometer and the ventilation-perfusion distributions by the multiple inert gas technique in 5 patients with acute pulmonary embolism. In these subjects there was a marked ventilation-perfusion inhomogeneity, as detected from inert gases and this finding was in agreement with the impairment of the alveolar to arterial gradients and of their derived indexes. Consideration on the responsible mechanisms for the disturbances of gas exchange are also reported. In conclusion these two computerized techniques provide a useful assessment of the ventilation-perfusion relationships in order to explain the disturbances of gas exchange in critically ill patients.

Acute Disease↗
PubMed1986

Respiratory effects of occupational exposure to tobacco dust.

Few investigations of the respiratory effects of occupational exposure to tobacco dust have been carried out and the threshold limit value has not well been established. A cross sectional survey on a sample of 223 male and female workers at a cigar and cigarette factory in Lucca (Tuscany) showed a significantly higher prevalence of wheezing, attacks of shortness of breath with wheezing, dyspnoea, and rhinitis than in a reference population. A trend towards a decrease in forced end expiratory flows according to smoking habit and work duration was evident. Positive skin prick tests were observed in 26% of men and 23% of women and were positively associated with duration of work and negatively with cigarette smoking. Thin interstitial space involvement was observed on chest x ray examination in almost half the female workers with more than 35 years exposure. These findings suggest that prolonged exposure to tobacco dust may have negative health effects and that it is advisable to establish a threshold limit value for tobacco dust different from that of inert dust.

Adult↗
PubMed1985

Lung involvement in Sjögren's syndrome: a comparison between patients with primary and with secondary syndrome.

Lung function was assessed in 20 patients with primary Sjögren's syndrome (SS) and in a group of patients with SS associated with a variety of connective tissue diseases. Signs of small airway disease and of altered diffusion capacity, together with chest x-ray features of mild interstitial involvement, were the most common findings in primary SS. On the whole, lung involvement was more frequent and severe in patients with the secondary form of the syndrome. In both primary and secondary SS lung function changes did not correlate with the other clinical and serological parameters, except for a more severe impairment of diffusion capacity in patients with Raynaud's phenomenon.

Adult↗
PubMed1985

[Respiratory function in chemical workers].

The authors have evaluated the trend of the forced expiratory flows at low lung volumes and of the diffusing capacity for CO in a group of chemical workers of a dye factory, exposed to mineral dusts, organic pigments and solvents. Prevalences of chronic bronchitis and dyspnea, as evaluated by CNR questionnaire, were 15 and 32%. FEF25-75, MEF50 and MEF75 showed statistically significant differences with reference values. The reduction of KCO% was almost completely accounted for by smoking habit. During exercise, DLCOSS2 did not reach the expected values. 71% of the subjects with a diagnosis of COLD had worked more than 15 years in the dye factory. These results suggest a negative effect of the working environment, together with cigarette smoking, on lung function of subjects with a medium-long-term exposure.

Carbon Monoxide↗
PubMed1984

[Role of tobacco smoking in the determination of CO diffusion impairment in silicotic patients].

Alveolar-capillary diffusion of CO was evaluated in 48 silicotics with predominantly small irregular opacities at low profusion. The mean value of CO diffusion lay between 82 and 87% of the reference values, except for DLCOSS2 which was slightly reduced (74% of theoretical). There was no correlation between the functional data and duration of work but there was a significant reduction of the CO diffusion values according to smoking, which was greatest in those smoking more than 15 pack-years. Subjects with small irregular opacities presented lower values than those with small "p" or "q" opacities, but this difference was not apparent when only non-smokers were considered.

Adult↗