Biomedical subjects
Publications and source records attributed to M Drent.
For enumeration of intracellular organisms (ICO) in bronchoalveolar lavage fluid samples, the May-Grünwald-Giemsa (MGG) stain displayed higher interobserver agreement than the acridine orange and Gram stains. The MGG stain offered a reliable enumeration of ICO when 200 cells were counted by one observer.
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We present the case of a patient who suffered from severe pneumonia. Extensive diagnostic procedures revealed negative cultures and a severe neutrophilia in the bronchoalveolar lavage fluid suggestive of Sweet's syndrome. The persistent toxic leukocyte differentiation (not induced by infection) suggested an underlying hematologic disorder. One week later, she developed cutaneous lesions indicative of neutrophilic dermatosis. Bone marrow investigation showed refractory anemia with excess of blasts (RAEB). Both the pulmonary and cutaneous infiltrates improved after treatment with chemotherapy.
BACKGROUND: Patients suffering from sarcoidosis may present with a wide range of symptoms. The aim of this study was to make an inventory of the clinical presentation of the sarcoidosis population in the Netherlands. METHODS: Symptom inventory questionnaires were sent to all members of the Dutch Sarcoidosis Society. Of these 1755 sarcoidosis patients, 1026 (58%), (age 46.7 +/- 11.6, female 63%) completed the questionnaire. RESULTS: Familial sarcoidosis was reported by 170 patients (16.3%). In 57% of the cases the first diagnosis was sarcoidosis. Other diagnosis included rheumatoid arthritis (5.1%) and tuberculosis (4.8%). Treatment with systemic corticosteroids was reported by 565 patients (55.1%). The most frequently reported symptom was fatigue (71%), followed by dyspnea (70%), arthralgia (52%), muscle pain (39), chest pain (27%), and general weakness (22%). Moreover, 26% of patients suffered from disease-related tension and strain. No relationship was found between the reported symptoms and treatment with corticosteroids. CONCLUSIONS: Sarcoidosis patients suffered from a broad range of persistent physical symptoms. In this study fatigue appeared to be the most commonly reported symptom. Intervention programs should focus on physical health as well as psychosocial aspects such as teaching patients how to cope with the disease.
Health-related quality of life (QOL) has become an important topic in health care. However, hardly any attention has been paid to QOL in sarcoidosis. Therefore, the aim of this study was to assess the impact of sarcoidosis on QOL. Sixty-four sarcoidosis patients completed the World Health Organization Quality of Life assessment instrument (WHOQOL-100) and the Beck Depression Inventory (BDI). For the WHOQOL-100 a matched group of healthy controls was selected. Patients were divided into two groups: group I (n = 37) consisted of patients with actual symptoms, group II (n = 27) consisted of asymptomatic patients. The WHOQOL-100 revealed a number of areas in which sarcoidosis patients, especially those with current symptoms, experienced problems. A major symptom in both groups of sarcoidosis patients was fatigue. No association between the facet fatigue and the domain psychological health was found. Depressive symptoms (BDI) were associated with psychological function (WHOQOL-100). No association between pulmonary function tests and QOL was found. In conclusion, this study shows that sarcoidosis has a considerable impact on the QOL of patients. The WHOQOL-100 appeared to be a sensitive instrument to measure fatigue--one of the most common symptoms in sarcoidosis--which otherwise is difficult to assess objectively.
An inflammatory response has been observed in lung cancer both locally and systemically. The aim of the present study was to investigate whether the alveolar compartment was involved in the inflammatory response in non-small cell lung carcinoma (NSCLC). Both inflammatory mediators in bronchoalveolar lavage fluid (BALF) and cytokines produced by alveolar macrophages (AM) were investigated. Twenty patients with newly detected NSCLC and nine control subjects were studied. The patients had not been treated with chemotherapy, radiotherapy or with systemic or inhaled corticosteroids. All patients and control subjects were current smokers or stopped smoking recently. BAL was performed in the affected lung as well as in the contralateral lung of NSCLC patients, and only unilaterally in control subjects. Comparable results were demonstrated for the levels of the of the inflammatory mediators TNF-a, Interleukin (IL)-6, IL-8, both soluble TNF receptors and the soluble adhesion molecules E-selectin and intercellular adhesion molecule (ICAM)-1 between the affected lung and the contralateral lung in the NSCLC population as well as between the NSCLC population and the control subjects. Moreover, no significant differences in cytokine profiles of AM were found between AM obtained from the affected lung and from the contralateral lung. Although BAL is a useful tool in the diagnostic procedure for NSCLC, the present findings suggest that BAL does not reflect the enhanced inflammatory state, as reported in plasma and in the interstitial compartment around the tumour cells in NSCLC.
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Systemic kinetics of three inflammatory mediators (bactericidal/permeability-increasing protein [BPI], soluble intercellular adhesion molecule [sICAM], and soluble E-selectin [sE-selectin]) were studied during the development of ventilator-associated pneumonia (VAP) (n = 42), diagnosed on quantitative cultures of bronchoscopic samples. From a pool of collected samples, nested samples were used to measure mediators on Days -4, -2, 0, and +2, relative to diagnosis. Correlations between systemic levels of mediators and clinical severity of infection (VAP with or without severe sepsis or septic shock) and patient outcome (mortality at Day 10 after diagnosis) were studied. Predictive values of inflammatory mediators were compared with daily Simplified Acute Physiology Score II (SAPS II) values and the logarithmic number of bacteria in bronchoscopic samples. During the development of VAP, increasing SAPS II scores and rising systemic mediator levels were only found in patients in whom VAP was accompanied with severe sepsis or septic shock. Values of SAPS II and plasma levels of BPI and sE-selectin, but not sICAM, increased from the day of diagnosis on in patients who died within 10 d of diagnosis. Systemic levels of inflammatory mediators did not better predict clinical severity or patient outcome than daily SAPS II scores. The logarithmic number of bacteria in bronchoscopic samples poorly correlated with circulating levels of inflammatory mediators, severity of infection, and patient outcome. Our findings show that a clinical scoring system (SAPS II score) is at least as good as a predictor for the clinical severity of infection and patient outcome, and provide new information on the kinetics of inflammatory mediators during the development of VAP.
The aim of this study was to assess the reproducibility of quantitative, spirometrically gated computed tomographic (CT) lung densitometry at defined levels of inspiration in hospitalized patients. On two consecutive days, spirometrically gated CT sections were obtained from 20 hospitalized patients at 5 cm above and 5 cm below the carina, and at 90 and 10% of the vital capacity (VC). The mean, modal and median lung densities were calculated, the cut-off points of the frequency distribution of Hounsfield units (HU) defining the lowest and the highest 10th percentile, as well as the histogram full width at half maximum. The lung density parameters of corresponding CT sections of both studies were compared. Reproducibility was expressed as the standard deviation of the signed difference between the results of Day 1 and Day 2 divided by the square root of 2. Reproducibility data were correlated with results of airflow limitation. At 90% VC, reproducibility was of the order of 3-14 HU in both lung zones. At 10% VC, reproducibility was worse by approximately a factor of three. No relationship was found between reproducibility and results of airflow limitation. In conclusion, objective measurement of lung density at spirometrically controlled levels of inspiration is a reproducible method in assessing pulmonary density. Reproducibility of lung density measurements is not influenced by severe respiratory insufficiency. The most reproducible computed tomographic lung density measurements can be obtained at 90% vital capacity.
BACKGROUND: Apart from the disease status, chronically ill patients are confronted with stressors like dependence, limitations in mobility and physical complaints. Data on patients with sarcoidosis, however, are lacking. The aim of this study was to investigate the quality of life (QOL) and the influence of QOL factors on depressive symptoms in these patients. PATIENTS AND METHODS: Sixty-four patients with histologically proven sarcoidosis participated in this study. Significant co-morbidity was excluded. The Sickness Impact Profile (SIP) was used to determine the QOL. Depressive symptoms were measured with the Beck Depression Inventory (BDI), of which a subset of items measured cognitive symptoms, the Cognitive Depression Index (CDI). Disease status was assessed by pulmonary function parameters (FEV1, Dco), complaints and illness duration. To control for a confounding cognitive style of self-report, the Positive Affect Negative Affect Schedule (PANAS) was administered. RESULTS: The major complaint was fatigue. QOL was related to the perception of complaints, but not to the assessed disease status. In a multivariate regression 86% of the variance could be explained in BDI-scores, and 83% in CDI-scores. After controlling for demographical factors, disease status and cognitive style, QOL contributed to the regression, explaining another 17% of variance of BDI-scores as well as CDI-scores. Problems with sleeping were associated positively with depressive symptoms in general (beta = 0.38) and depressive cognitions only (beta = 0.32). CONCLUSIONS: In sarcoidosis, QOL factors were associated with depressive symptoms. These results suggest that patients with sarcoidosis may profit from attention to the psychosocial as well as the somatic aspects of this disease.
Sarcoidosis has been associated with muscle involvement. In general, this involvement remains asymptomatic. The following case report demonstrates a patient with a 4-mo history of sarcoidosis who reported severe fatigue and slight muscular complaints at a regular checkup. Gallium scintigraphy indicated unexpected and unusually extensive muscular localizations of the disease. The latter findings were confirmed by examination of biopsy specimens. The importance of gallium scintigraphy lies in the possibility of wholebody screening for inflammation localizations, particularly when physical, laboratory, lung function and radiographic examinations fail to provide convincing evidence of active sarcoidosis. Furthermore, it can be helpful in the follow-up of the effect of supportive treatment.
UNLABELLED: BACKGROUND AND AIMS OF THE WORK: Although it often has been suggested that members of patient organisations concerning a particular disease might not be representative of patients with that particular disease in general, this hypothesis has not been tested. Therefore, the aim of this study was to evaluate whether the quality of life (QOL) of members of the Dutch Sarcoidosis Society (DSS) is comparable with the QOL of a random non-member sample of the Dutch sarcoidosis population. SUBJECTS AND METHODS: The study included 64 out-patients (Group I), 192 DSS members matched for age and gender (Group II), and 192 DSS members matched for age, gender, as well as symptoms (Group III). All subjects filled in a questionnaire to make an inventory of physical symptoms and the World Health Organization Quality of Life assessment instrument (WHOQOL-100). The Student's t-test was used to evaluate the differences between (i) the two DSS groups and (ii) the non-member group. RESULTS: Group III differed significantly from Group I in only one QOL domain and five facets. Moreover, considering only the patients with symptoms from Group I and Group III, differences emerged on one domain and two facets. CONCLUSIONS: It appeared that more members of the DSS declared they suffered from physical symptoms than non-members. When the experience of symptoms was partialled out fewer QOL differences remained.
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Serum lactate dehydrogenase (LDH) activity, a marker of cell damage, is increased in several pulmonary disorders, especially when fibrosis is involved. In rats exposed to silica, high levels of LDH activity were found. A rise of serum LDH3 has been associated with lung tissue injury. The aim of this study was to investigate the serum LDH isoenzyme pattern after coal-dust exposure and the possible relation to pulmonary function tests. Ex-coalminers (n = 201), with a history of coal-dust exposure more than 20 yr ago, were admitted to the authors' hospital for a medical check-up and were included in the study. The serum LDH activity was found to be elevated in 79.1% of the ex-coalminers (634 +/- 245 U I-1). Moreover, in 196 of the 201 cases (97.5%), a high LDH3 level (31 +/- 4%) was demonstrated. A moderate negative relation was found between the forced expiratory volume in 1 s (FEV1) and the LDH activity (r = -0.26; P < 0.001), as well as between FEV1 and LDH3 activity (r = -0.23; P < 0.001), even in the subgroup (n = 42) with a normal LDH. All other liver function tests were within normal limits. These results suggest that coal-dust, even many years after the actual exposure, causes an increase in the total serum LDH activity and changes in the LDH-isoenzyme pattern, mainly characterized by a high LDH3 activity.
Four case histories are reported in which the initial signs and symptoms were those of pulmonary infiltration and in which subsequently a diagnosis of myelodysplasia was made. The analysis of bronchoalveolar lavage fluid--demonstrating predominantly neutrophils and lymphocytes, and, occasionally blast cells as well as plasma cells--indicated that the pulmonary infiltration was related to the myelodysplastic process. As no other causes of pulmonary infiltration could be found, it seems that a pulmonary infiltrate can be the presenting symptom of a myelodysplastic syndrome. Although pleuropulmonary infiltrates most often are caused by infections, these cases illustrate that myelodysplasia related infiltrates should also be considered.
Ventilator-associated pneumonia (VAP) is the most frequent occurring infection among mechanically ventilated patients. The clinical presentation of VAP ranges from relatively benign to a severe illness with septic shock. The influence of VAP on patient outcome has not been elucidated and its effects on the inflammatory response of the host are unknown. In a case-control study, the systemic inflammatory response was investigated in patients developing VAP as compared with control patients matched on duration of mechanical ventilation and underlying diseases. Patients developing VAP (n = 42) were matched to a single control (without VAP), who was matched on seven variables. VAP was diagnosed with bronchoscopic techniques. The inflammatory response, reflected by circulating levels of interleukin-6 (IL-6) and interleukin-8 (IL-8), was determined on the day of diagnosis (or day of matching for controls), 4 and 2 d before diagnosis, and 2 d after diagnosis. The development of VAP was not associated with an increase in circulating levels of IL-6 or IL-8. Among patients in which VAP was associated with a clinical presentation of severe sepsis or septic shock (n = 10), IL-6 and IL-8 levels increased and were higher than in the corresponding controls. Moreover, 60% of cases with severe sepsis or septic shock died as compared with 20% of their matched controls (p = 0.06). Mortality rates were similar in patients with uncomplicated VAP and their matched controls (25% and 34%, respectively). High circulating levels of IL-6 and IL-8 were associated with higher mortality rates. The clinical picture of VAP can be subdivided into different types, ranging from uncomplicated to an infection associated with severe sepsis or septic shock, elevated circulating levels of IL-6 and IL-8, and an increased mortality rate.
In sarcoidosis, pulmonary and general symptoms often do not correlate with radiographic stage and routinely performed lung function tests. Asymptomatic muscle involvement in sarcoidosis is common, but little is known about respiratory muscle involvement. The aim of this study was to investigate any relationships between persistent complaints and/or quality of life and respiratory muscle strength and endurance, respectively. Measurements of maximal inspiratory and expiratory mouth pressures (PI,max and PE,max), respiratory muscle endurance and routine lung function were made in 18 patients with sarcoidosis. To assess health status and quality of life, patients completed the Sickness Impact Profile (SIP). Respiratory muscle strength and endurance time were lower in the patient group than in a group of healthy controls (p=0.05). Compared to a general population, the patients with sarcoidosis were found to be limited in physical and psychosocial functioning. The respiratory muscle endurance time correlated with the SIP subscales "mobility" (r=-0.56; p<0.01), and "body care and movement" (r=-0.79; p<0.001). The total lung capacity (TLC), inspiratory vital capacity (IVC) and forced expiratory volume in one second (FEV1) were normal in all subjects. In conclusion, patients with sarcoidosis and normal lung function showed reduced respiratory muscle strength and endurance time. Correlations were found between these indices and both symptoms and certain Sickness Impact Profile domains. Therefore, we suggest inclusion of measurements of respiratory muscle strength in the assessment and follow-up of patients with sarcoidosis.