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Biomedical subjects

T Pieters

Publications and source records attributed to T Pieters.

At least 19 recordsLinked to original sources
PubMed2001

Serum Clara cell protein (CC16), a marker of the integrity of the air-blood barrier in sarcoidosis.

To test the hypothesis that sarcoidosis is associated with an intravascular leakage of lung epithelium secretory proteins, the occurrence and determinants in serum of sarcoid patients of CC16, a small size and readily diffusible lung-specific protein of 16 kDa secreted by bronchiolar Clara cells, was investigated. CC16 was measured by a sensitive latex immunoassay in the serum of 117 patients with established sarcoidosis and of 117 healthy subjects matched for age, sex and smoking status. Stepwise regression analysis was used to identify extrapulmonary variables of CC16 changes in serum. These changes were then compared with biochemical and cellular parameters in bronchoalveolar lavage fluid (BALF) as well as with the number of CC16 immunostaining cells on bronchial or pulmonary biopsy samples. CC16 concentration in serum of sarcoid patients was significantly increased, compared to their matched controls (25.9 +/- 16.2 versus 13.9 +/- 5.2 microg x L(-1)). In nonsmoking patients without significant renal impairment, CC16 in serum increased with the severity of the chest radiograph and computed tomography changes, and was on average 50-100% higher when parenchymal involvement was present. Sarcoid patients had, however, normal levels of CC16 in BALF and an unchanged number of CC16-immunopositive cells in lung biopsy samples, suggesting that an increased secretion of CC16 in the sarcoid lung is very unlikely, and that the elevation of CC16 in sarcoidosis results from an increased intravascular leakage of the protein across the air-blood barrier. The present study suggests that CC16 in serum might provide a useful tool to noninvasively evaluate the damage and increased permeability to proteins of the air-blood barrier associated with sarcoidosis.

Adult↗
PubMed2001

Non-specific interstitial pneumonia showing a "crazy paving" pattern on high resolution CT.

Non-specific interstitial pneumonia is characterized pathologically by uniform interstitial inflammation and fibrosis. This disease is most commonly demonstrated on high resolution CT as subpleural ground-glass opacity mixed with irregular linear opacities. The authors report a case of non-specific interstitial pneumonia with high resolution findings consistent with a "crazy paving pattern". This appearance, represented by smoothly thickened interlobular septa with a background of geographic areas of ground-glass opacity, is unusual for non-specific interstitial pneumonia and was indistinguishable from other interstitial or alveolar lung diseases.

Biopsy↗
PubMed2000

Lung function study and diffusion capacity in anorexia nervosa.

STUDY OBJECTIVES: In humans, malnutrition alters the respiratory system in different ways. It impairs the ventilatory drive, decreases respiratory muscle strength and reduces immune competence. In addition, typical emphysema-like changes were demonstrated in starved animals. The presence of emphysema has never been demonstrated in starved humans. Our objective was to investigate whether pulmonary emphysema occurs in anorexia nervosa by means of a pulmonary function study. POPULATION AND METHOD: We examined 24 women aged between 14 and 38 years (nine smokers). We studied the lung function including lung volumes, ventilatory capacity, maximal respiratory pressures and transfer factor, as well as PaO2. RESULTS: All respiratory tests were within normal limits with the exception of decreased maximal inspiratory (59% of predicted values) and expiratory pressures (35%), and increased residual volume (162%). Diffusion capacity (98.1 +/- 16.2%) and transfer coefficient (98.4 +/- 16.2%) were also normal. The diffusion coefficient was lower in current smokers than in those who had never smoked (P < 0.01), a difference similar to that calculated from existing reference values for transfer factor for smokers and nonsmokers. CONCLUSION: In anorexia nervosa, pulmonary function tests are within normal limits with the exception of maximal pressures and residual volume. Diffusion capacity is not decreased. The present results within the limitations of the used method are not compatible with the hypothesis of starvation-induced pulmonary emphysema.

Adolescent↗
PubMed1999

Rupture of aortic aneurysm with right-sided haemothorax.

A 62-yr-old male with a history of high blood pressure was admitted for persistent dyspnoea and a right-sided pleural effusion, complicated by a recent episode of shock. There was no history of trauma and the patient denied any thoracic pain. A chest tube was inserted which released nonclotting bloody fluid. A thoracic computed tomographic scan of the chest revealed an aneurysm of the inferior third of the descending thoracic aorta. The patient underwent a successful prosthetic graft replacement. We emphasize that rupture of aortic aneurysms should be considered in the evaluation of spontaneous haemothorax even if it is right-sided and not associated with pain.

Aortic Aneurysm, Thoracic↗
PubMed1998

Lung granulomatosis in a dental technician.

BACKGROUND: Dental technicians are potentially exposed to various occupational dusts and chemicals. Not surprisingly, occupational related lung diseases have been documented in this population. METHODS: We describe the case of a dental laboratory technician presenting progressive exertional dyspnea and cough. We used lung function tests, computed tomography, histological examination, mineralogical and immunological studies to characterize his condition. RESULTS: Lung function studies disclosed a restrictive pattern with a low diffusion capacity. A high-resolution CT scan revealed the presence of micronodules in both lungs corresponding to non-caseating foreign body granulomas at histological examination. Mineralogic studies showed the presence of silica, silicates, and aluminum. The lymphocytic transformation test was positive with the bronchoalveolar lavage for beryllium. CONCLUSIONS: This dental technician developed pulmonary granulomatosis. Combined histological, mineralogical, and immunological studies led us to consider the diagnosis of pneumoconiosis most likely related to occupational exposure to beryllium and aluminum.

Adult↗
PubMed1998

Effects of Breathe Right on snoring: a polysomnographic study.

The nasal vestibule is a major site of resistance to airflow in healthy subjects. A high nasal resistance may increase snoring. Activation of the alae nasi and alar retraction reduce resistance to airflow and improve ventilation. The Breathe Right (BR) device has been proposed to reduce or eliminate snoring by improving nasal breathing. We assessed the efficacy of BR on sleep quality and snoring during 2 full-night polysomnographies, the first without and the second with BR. Ten non-apnoeic snorers were studied. Snoring was present during 22-98% of total sleep time during the control night. Ear-nose-throat examination disclosed a nasal valve anomaly in five subjects, objectivated by anterior and posterior rhinomanometry. Quality of sleep and snoring were not influenced by BR, even when different sleep stages were analysed separately. No difference in snoring index was found between snorers with or without nasal valve anomaly. We conclude that BR is ineffective in relieving snoring in non-apnoeic snorers.

Adult↗
PubMed1998

Uptake of In-111 pentetreotide by pleural plaques.

Somatostatin receptor imaging with In-111 pentetreotide has been validated for the diagnosis and staging of chest tumors with neuroendocrine differentiation such as bronchial carcinoid and small cell lung cancer. In-111 pentetreotide uptake is not specific for neuroendocrine tumors because somatostatin receptors are also expressed by white blood cells, leading to the in vivo visualization sites of infection sites or active inflammation. Pleural plaques may be due to asbestos exposure or tuberculosis. Presented here are three cases of In-111 pentetreotide uptake in pleural plaques. This uptake by benign lesions may be misleading in the diagnostic work-up of patients with lung tumors.

Aged↗
PubMed1998

Clara cell protein (CC16) in pleural fluids: a marker of leakage through the visceral pleura.

Pleural fluid (PF) proteins either derive from serum by diffusion or are locally secreted within the pleural space. Another hypothetical origin is a leakage of lung secretory proteins across the visceral pleura. To test this hypothesis, we investigated the occurrence, sources, and determinants in PF of CC16, a small-size and readily diffusible protein of 16 kDa secreted by bronchiolar Clara cells. CC16 concentration was determined by a sensitive latex immunoassay in serum and PF of 117 subjects (86 exudates and 31 transudates) and, for purpose of comparison, in ascites samples from another group of 38 subjects (7 exudates and 31 transudates). CC16 was also studied in serum and PF of normal rats and in rats with pleural exudate induced by alpha-naphthyl-thiourea (ANTU). The levels of CC16 in PF and ascites were highly correlated with that in serum, suggesting a diffusional exchange across the pleural/blood and peritoneal/blood barriers. Whereas CC16 occurs at similar levels in ascites and serum, the protein was found to be more concentrated in PF than in serum in both humans (geometric mean in microg/L, 26.2 versus 14.6, p < 0.0001) and rats (213 versus 16.2, p < 0.001). A local synthesis of CC16 appeared unlikely in view of the lack of CC16-immunostaining in pleura of both species. The only plausible explanation for these findings is that CC16 in PF originates from two sources: diffusion from plasma and a leakage from the lung into the pleural space across the semipermeable visceral pleura. This interpretation is supported by a markedly increased leakage of CC16 in experimental exudates induced by ANTU and the finding of high CC16 concentrations in human transudates associated with congestive heart failure, two conditions wherein PF has been shown to arise from the interstitial spaces of the lung.

Aged↗
PubMed1996

[Pleural effusion and severe edema of the lower limbs induced by bromocriptine].

High doses of bromocriptine used for treatment of Parkinson's disease may be associated with pleuropulmonary complications. Isolated pleural effusions are a rare manifestation as is lower limbs edema are an exceptionally one. We report the case of a 67-year-old man, treated since five years by a daily dose of 30 mg of bromocriptine for Parkinson's disease, who developed important leg's edema and a few months later an exsudative right pleural effusion. No etiologies were found. Bromocriptine was discontinued. The evolution was characterized by nearly complete resolution of pleural effusion and disparition of lower limbs edema.

Aged↗
PubMed1996

Nocardiosis: a rare cause of pleuropulmonary disease in the immunocompromised host.

We report a case of acute pleuropulmonary nocardial infection in a 24-year-old woman suffering from systemic lupus erythematosus. In most instances, No-cardia asteroides is an opportunistic pathogen. In our patient, the infection was facilitated by systemic lupus erythematosus and chronic use of corticosteroids and immunosuppressive drugs. N. asteroides was cultured from both pleural effusion and blood. No extrathoracic location was found and the patient improved upon intravenous antibiotics and pleural drainage. Owing to the poor tolerance of trimethoprim/sulfamethoxazole, the patient was treated successfully with imipenem. The predisposing factors, the clues to the diagnosis and the therapy of nocardiosis are briefly reviewed.

Adult↗
PubMed1996

Acceptance and long-term compliance with nCPAP in patients with obstructive sleep apnoea syndrome.

Previous studies have generally shown poor effective long-term compliance with nasal continuous positive airway pressure (nCPAP) in patients with obstructive sleep apnoea syndrome (OSAS). We performed a retrospective study of patients treated with nCPAP for more than one year. Compliance was defined as the average number of hours of nCPAP use per day, where hours of use were obtained from the built-in time counter of the nCPAP device, after deduction of the 10% difference between effective use and time counters previously shown by others. We present data on the first 95 patients for whom results were available. The follow-up period was 784 +/- 366 (mean +/- SD) days for the whole group. Compliance was 5 +/- 1.8 h. For a subgroup of 36 patients, we had data on two consecutive follow-up periods (673 +/- 235 and 390 +/- 147 days for the first and second period, respectively). Compliance remained stable (5.2 +/- 1.5 and 5 +/- 2.3 h, respectively). For the whole group, a significant correlation was found between compliance and sleep fragmentation expressed as the movement arousal index (r = 0.226). During a similar 3 year period, 155 patients with a confirmed diagnosis of OSAS were offered a nCPAP trial. CPAP was actually delivered for home use to 117 patients (76%). During this same 3 year period, only 21 patients out of a total of 192 followed-up in our institution quit treatment, mainly due to intolerance or cure. These results indicate that in a nonselected group of obstructive sleep apnoea syndrome patients a high and stable compliance with nasal continuous positive pressure can be achieved, contradicting recent results of other series.

Adult↗
PubMed1995

Normal pregnancy in primary alveolar hypoventilation treated with nocturnal nasal intermittent positive pressure ventilation.

Nocturnal nasal intermittent positive pressure ventilation (NIPPV) is increasingly used to treat chronic respiratory failure in a wide variety of conditions (myopathies, Ondine's curse, kyphoscoliosis, etc.) and allows a normal everyday life. Some of these diseases affect women of childbearing age. We report on a young woman suffering from primary alveolar hypoventilation, who presented with limitation of daytime activities, severe oxygen desaturation during sleep, polycythaemia and pulmonary hypertension. These abnormalities completely reversed after a few months of NIPPV applied through a nasal mask. Whilst under ventilatory assistance during sleep, she had an uneventful pregnancy and delivery of a normal baby. We suggest that in selected patients requiring NIPPV, pregnancy can be contemplated with a reasonable level of safety both for the mother and the child, provided that adequate mechanical ventilatory assistance during sleep is maintained throughout pregnancy.

Adult↗
PubMed1992

Diurnal and nocturnal diuresis and natriuresis in obstructive sleep apnea. Effects of nasal continuous positive airway pressure therapy.

Excessive nocturnal diuresis and natriuresis have been reported in patients with sleep apnea. The mechanisms responsible for these alternations in nocturnal renal function have not been clearly identified. To gain further insight into this matter, we studied 12 patients (one woman) with a mean +/- SD age of 50 +/- 9 yr and body mass index of 36.9 +/- 8.6 kg/m2. Polysomnography showed in all a sleep apnea syndrome with an apnea-hyponea index (AHI) of 81.3 +/- 41.7. Treatment with nasal continuous positive airway pressure (nCPAP) resulted in an AHI of 19.4 +/- 13.7 and in normalization of sleep characteristics. Diurnal renal function was normal in all subjects. Although untreated, patients showed an abolition of the well-known decrease in diuresis and natriuresis during the night (diurnal and nocturnal diuresis 56.3 +/- 26.8 and 77.2 +/- 33.4 ml/h, respectively, p = NS; diurnal and nocturnal fractional urinary Na+ excretion 0.42 +/- 0.09 and 0.70 +/- 0.55 ml/100 ml glomerular filtration [GF], respectively, p = NS). Results of nocturnal studies under nCPAP therapy showed a significant decrease in diuresis and natriuresis (nocturnal diuresis before and under nCPAP, respectively: 90.4 +/- 27.3 and 70.6 +/- 25.1 ml/h, p less than 0.02; nocturnal fractional urinary sodium excretion before and under nCPAP, respectively: 0.76 +/- 0.53 and 0.44 +/- 0.37 ml/100 ml GF, p less than 0.03). Morning blood levels of renin, aldosterone, antidiuretic hormone, epinephrine, and atrial natriuretic factor showed no significant difference before and under nCPAP, whereas norepinephrine significantly decreased from 309.5 +/- 104.2 before to 230.4 +/- 88.4 pg/ml under nCPAP (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Circadian Rhythm↗