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I L Paradis

Publications and source records attributed to I L Paradis.

69 records · Page 4Linked to original sources
PubMed1986

Role of inflammation in the lung disease of systemic sclerosis: comparison with idiopathic pulmonary fibrosis.

Alveolar inflammation is thought to underlie the development of pulmonary fibrosis in several forms of diffuse lung disease including the connective tissue diseases. The relationship between inflammation and the clinical manifestations of systemic sclerosis (scleroderma), such as skin and lung involvement, is less clear. We therefore evaluated 14 never-smoking patients with systemic sclerosis with pulmonary involvement by bronchoalveolar lavage (BAL) and compared the results with those found in eight nonsmoking patients with idiopathic pulmonary fibrosis (IPF) and eight normal subjects. The patients with scleroderma also underwent gallium citrate Ga 67 scanning. We found that patients with scleroderma and pulmonary involvement have alveolitis that appears to wane with time. In addition, patients with systemic sclerosis have a cellular profile in lavage fluid that appears to differ from that of patients with IPF. Finally, we found a significant correlation between BAL cellular recovery and the single-breath carbon monoxide diffusing capacity in patients with systemic sclerosis but not in patients with IPF. We conclude that inflammation may play an important role in the pathogenesis of the pulmonary disease of scleroderma and that different mechanisms may lead to fibrosis in IPF and scleroderma.

Adult↗
PubMed1985

Interactions between bronchoalveolar lymphocytes and macrophages in heart-lung transplant recipients.

Bronchoalveolar lavages (BAL) were obtained from heart-lung transplant patients. Following transplantation, the number of lymphocytes and macrophages are considerably increased. BAL lymphocytes frequently exhibit donor specific secondary allogeneic proliferation measured in primed lymphocyte testing (PLT) assays. We report our findings regarding a persistence of donor derived macrophages and lymphocytes in BAL during the posttransplant period. The presence of donor specific macrophages causes a proliferative response of alloreactive BAL lymphocytes from the recipient. This "Bronchoalveolar Macrophage Lymphocyte Reaction," or "BMLR," may represent a unique aspect of in vivo interactions associated with lung allograft responses. Comparative studies showed considerably lower PLT responsiveness of peripheral blood lymphocytes than that of BAL lymphocytes. These studies suggest that functional assays on BAL cells may be useful in monitoring lung transplant rejection and other immunological phenomena that affect pulmonary function of heart-lung transplant patients.

Bronchi↗
PubMed1984

Lymphocyte enumeration: a comparison between a modified avidin-biotin-immunoperoxidase system and flow cytometry.

The reliability and sensitivity of an indirect avidin-biotin-peroxidase (ABC) procedure for enumerating lymphocyte subpopulations was compared to flow cytometry (FC) employing direct immunofluorescence. Lymphocytes were enumerated by two different methods. For counting method I, which is the method of conventional FC, the number of immunostained lymphocytes was compared to the total number of lymphocytes present. The ABC procedure by method I detected a greater proportion of immunostained lymphocytes for all subsets tested than did FC. By counting method II, where the number of immunostained lymphocytes is compared to the total number of cells present, the ABC analysis still detected more total T cells than FC but the results for the two analyses were similar for T helper and T suppressor cells. Thus, the ABC technique appears to be a valid method for enumerating T lymphocyte subsets. Furthermore, as compared to FC, it offers the advantages of reduced cost, simplicity of understanding and performance, need for fewer cells, and a permanent record of lymphocyte staining. For these reasons, we feel that the ABC technique will enjoy widespread application for the identification of lymphocyte membrane antigens.

Antigens, Surface↗
PubMed1979

Traumatic pneumocephalus: a hazard of resuscitators.

A patient with traumatic pneumocephalus following use of an oxygen-powered resuscitator with a face mask is presented. Pressures of 50 cm H2O delivered by the device apparently were sufficient to force air into the cranium through a fracture communicating with the nasal cavity. The authors feel that manual-powered resuscitators should be used on patients suspected of skull fracture.

Adult↗
PubMedDate not supplied

Lymphocyte phenotypes at tumor margins in patients with head and neck cancer.

Lymphocyte phenotypes were identified by monoclonal antibodies and avidin-biotin peroxidase reagents and enumerated in tumor tissue removed from 26 patients with head and neck cancer. T lymphocytes (T11) were the predominate phenotype at the tumor margin, with twice as many helper/inducer (T4) as suppressor/cytotoxic (T8) lymphocytes. Patients with Stage II and III carcinoma of the glottis, tongue, and hypopharynx had significantly increased numbers of all T lymphocyte phenotypes when compared to patients with Stage IV disease, thus achieving statistical significance for the T11 and T8 phenotypes. All patients were followed for 2.5 years; those patients who remained free of malignant disease had an increased number of all T lymphocyte phenotypes compared to patients with recurrent malignancy, but this did not achieve statistical significance. Thus, increased numbers of T11 positive lymphocytes of both the T4 and T8 subsets in the tissue at the margins of head and neck tumors were associated with a more favorable prognosis. These results support the concept of an immunologic reaction at the tumor margin, which may be limiting the growth and spread of tumor.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Distinguishing between infection, rejection, and the adult respiratory distress syndrome after human lung transplantation.

The adult respiratory distress syndrome, bacterial pneumonia, cytomegalovirus pneumonitis, acute rejection, or a combination thereof were the primary causes of radiographic infiltrates or gas exchange abnormalities that occurred early after lung transplantation. The time of occurrence after transplantation, standard measures of clinical assessment as for nontransplant patients (i.e., vital signs, weight, white blood cell count, sputum, and cultures, etc.), bronchoalveolar lavage, and transbronchial lung biopsy were the primary tools used to analyze these situations. Bacterial pneumonia always occurred after postoperative day 2, acute rejection after postoperative day 5, and cytomegalovirus pneumonitis after postoperative day 16. Although cultures of bronchoalveolar lavage fluid were useful to detect pneumonia caused by bacteria, virus, and fungus, the types of cells recovered by bronchoalveolar lavage were not diagnostic of any type of disorder. Transbronchial lung biopsy was necessary to detect acute rejection and cytomegalovirus pneumonitis. Thus the cause of an early radiographic infiltrate or impairment of gas exchange was almost always reliably determined by using standard tools of clinical assessment, knowledge of the usual temporal sequence of the complications, and judicious use of bronchoalveolar lavage and transbronchial lung biopsy.

Biopsy↗
PubMedDate not supplied

Cytomegalovirus infection and survival in lung transplant recipients.

Fifty-nine patients who survived more than 30 days after lung transplantation (52 heart-lung, seven double lung, and two single lung) were studied for mortality and morbidity related to cytomegalovirus (CMV) infection. CMV infection developed in 32 patients (54%) and was more common in the preoperatively CMV seropositive group (95%) as compared with the seronegative group (38%). Symptomatic infections, pneumonitis, and CMV-related mortality, however, were higher in the seronegative (primary infection) group and actuarial survival was worse in these patients (40% and 23% at 1 and 5 years, respectively). Transplantation of CMV-seropositive donor organs was associated with a significantly higher incidence of primary infection and use of seronegative blood products led to a decrease in the primary CMV infection rate. The mortality of primary CMV infection was 54% and this was associated with a significantly higher rate of pulmonary superinfections in the first year after transplantation. The incidence of late pulmonary infections was associated with the development of chronic rejection rather than CMV status. We conclude that primary CMV infection has a major impact on the outcome after lung transplantation. The high mortality of primary infections justifies an aggressive approach to prevention and treatment in the at-risk seronegative group.

Actuarial Analysis↗
PubMedDate not supplied

A comparison of modified methenamine silver and toluidine blue stains for the detection of Pneumocystis carinii in bronchoalveolar lavage specimens from immunosuppressed patients.

Pneumonia due to Pneumocystis carinii is an increasingly frequent occurrence; a prompt, accurate diagnosis is important to successfully manage this infection. Methenamine silver and toluidine blue stainings of material recovered by bronchoalveolar lavage (BAL) have been the most widely employed techniques for detecting Pneumocystis organisms. The value of these two staining techniques for the detection of Pneumocystis organisms was prospectively compared in 220 BAL specimens obtained from 186 immunosuppressed individuals. The patients included those with disease-related and therapy-related immunosuppression; half of the BAL specimens came from organ transplant recipients. The results indicate that neither method is superior to the other and that both will correctly identify almost all Pneumocystis infections if a sufficient aliquot of BAL material is examined systematically by trained individuals. The toluidine blue method is somewhat simpler to perform, however. The reasons for discrepant results between the two staining methods were analyzed.

False Negative Reactions↗
PubMedDate not supplied

Influence of the donor lung on development of early infections in lung transplant recipients.

Infection of the lung allograft is the greatest cause of morbidity and mortality after heart-lung transplantation. To better understand the pathogenesis of these infections, we compared the results from cultures of the donor tracheas with the type and prevalence of early intrathoracic infections in the recipients. In the last 37 recipients, intrathoracic infections occurred within 2 weeks of operation in 16 (43%). Organisms isolated from the donor tracheal cultures were different from those associated with early infections, except for three of four recipients with heavy growth of Candida in donor tracheal cultures, in whom fatal invasive candidiasis developed caused by the same species of Candida isolated from the donor culture. Comparisons were made between recipients with (n = 16) and without early infection (n = 21) for age of donors and recipients, ischemic time, length of donor stay in an intensive care unit, donor arterial oxygen pressure, duration of recipient intubation, sterile donor tracheal culture or culture with presence of mouth flora, bacterial pathogens, or Candida, method of lung preservation, and antibiotic prophylaxis of donor. The only factor significantly associated with the onset of early infection was the presence of mouth flora in the donor tracheal culture (p = 0.004, Fisher's exact test, two sided). Multiple logistic regression was performed to test the additional contribution of other covariates after adjusting for the presence of mouth flora. None of the other covariates contributed to the occurrence of early infection. Recipients with early infection had a significantly lower survival compared with those without early infection (p = 0.04) by the Kaplan-Meier survival analysis.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Bronchoalveolar lavage in heart-lung transplantation.

Distinguishing lung rejection from infection in patients who have undergone heart-lung transplantation is difficult. Since bronchoalveolar lavage has been safely used to investigate other pulmonary conditions, its safety and the value of the cellular data obtained were evaluated on 44 occasions in ten heart-lung transplant recipients. This study established that bronchoalveolar lavage is safe after heart-lung transplantation, that it reliably diagnoses infection, and lastly that serial lavages are valuable in finding subclinical Pneumocystis carinii infections. The study failed to distinguish pulmonary infection from rejection. Nevertheless, the functional analysis of the cells obtained by bronchoalveolar lavage may yield information about the immune status of the allograft.

Bacterial Infections↗
PubMedDate not supplied

Lymphocytes of bronchoalveolar lavages from heart-lung transplant recipients.

Bronchoalveolar cells from 13 lavages done in six heart-lung transplant recipients were tested for spontaneous proliferation, Interleukin-2 response and secondary allogeneic proliferation measured by primed lymphocyte testing. In most instances the bronchoalveolar cells responded to Interleukin-2 suggesting the presence of activated T-cells in the lavage. The lavage cells from several patients exhibited primed lymphocyte testing responses suggesting the presence of alloreactive T-cells. A high degree of spontaneous cellular proliferation was observed in several lavages, which appeared to be due to a macrophage-lymphocyte reaction. Two mechanisms may be responsible for this reactivity; a macrophage-lymphocyte reaction as a result of recipient lymphocyte responses to donor macrophages in the lavage during the early post-transplant period, or a macrophage-lymphocyte reaction related to an ongoing infection. Thus, functional assays on bronchoalveolar lavage cells may have diagnostic value in monitoring heart-lung recipients for lung rejection and infection.

Bronchi↗
PubMedDate not supplied

HLA phenotype of lung lavage cells following heart-lung transplantation.

A transplanted lung contains a full complement of immunocompetent lymphocytes and macrophages that are able to react immunologically with recipient lymphocytes and macrophages. In this study, the origin of lymphocytes and macrophages recovered from sequential bronchoalveolar lavages of six heart-lung transplantation recipients was determined by histocompatibility phenotyping. We found that during the first four weeks after transplantation there is a rapid replacement of the donor cells with those of the recipient. Since lung rejection rarely occurs after this transition is complete, donor lymphocytes and macrophages may be an important component of the rejection process. Furthermore, the transition from donor to recipient phenotype indicates that the vast majority of human alveolar macrophages originate from bone marrow precursors.

HLA Antigens↗
PubMedDate not supplied

Comparison of outcomes after single and bilateral lung transplantation for obstructive lung disease.

BACKGROUND AND METHODS: To determine the long-term functional outcome for single versus bilateral lung transplant for nonseptic obstructive lung disease, we compared the results from 39 single and nine bilateral lung transplant procedures. The nine bilateral lung transplants included three en bloc double lung and six bilateral sequential lung transplants. RESULTS: Early deaths within 30 days of transplantation occurred in two of nine (22%) bilateral and 4 of 39 (10%) single lung transplants (p = Not significant). Compared with pretransplant values, pulmonary function as assessed by the spirometric indexes of the percent predicted forced vital capacity, forced expiratory volume in one second, forced expiratory volume in one second/forced vital capacity, and forced expiratory flow at 25% and 75% of forced vital capacity improved significantly up to at least 12 months after transplantation for both single and bilateral lung transplant recipients. The degree of pulmonary function improvement was better in single as compared with bilateral lung recipients. By 6 months after transplantation, all but one single and all bilateral lung recipients were in New York Heart Association class I or II (p = Not significant). One-year survival was significantly better after single (77%) compared with after bilateral lung transplantation (35%) (p < 0.05). CONCLUSIONS: These results suggest that single lung transplantation is the procedure of choice for patients with nonseptic obstructive lung disease.

Adolescent↗
PubMedDate not supplied

Lymphangioleiomyomatosis: recurrence after lung transplantation.

Pulmonary lymphangioleiomyomatosis is a disease principally affecting women during child-bearing years that eventually leads to respiratory failure. Recently, it has been listed as an indication for lung transplantation. To date, no cases of recurrent lymphangioleiomyomatosis after lung transplantation have been reported, unlike the experience with sarcoidosis and giant cell interstitial pneumonia. At the University of Pittsburgh Medical Center, four patients have undergone single-lung transplantation for lymphangioleiomyomatosis. We now report that one of these cases developed recurrent lymphangioleiomyomatosis in the allograft lung.

Female↗