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At least 19 recordsLinked to original sources

PubMed1998

Does bronchial artery revascularization influence results concerning bronchiolitis obliterans syndrome and/or obliterative bronchiolitis after lung transplantation?

OBJECTIVE: To study the frequency of histological obliterative bronchiolitis and clinical bronchiolitis obliterans syndrome after en bloc double lung transplantation with bronchial artery revascularization and bilateral lung transplantation without bronchial artery revascularization. METHODS: Primary en bloc double lung transplantation with bronchial artery revascularization using the internal mammary artery as conduit was performed in 62 patients. The frequencies of obliterative bronchiolitis and bronchiolitis obliterans syndrome have been established from transbronchial biopsies and lung function measurements. Results have been analyzed in relation to the arteriographic success of bronchial artery revascularization and have been compared to results from Stanford University, obtained through personal communications. RESULTS: Survival after 1, 2, 3, 4 and 5 years was 85, 81, 69, 69, and 69%, respectively. Fifteen patients developed bronchiolitis obliterans syndrome while seven developed obliterative bronchiolitis. Survival was superior for patients with bronchial artery revascularization classified as complete or incomplete bilateral versus incomplete hemilateral, incomplete poor or failed (P = 0.016, log-rank test). For patients surviving > or = 3 months post-transplant, the post-operative baseline FEV1 was lower for patients who later developed bronchiolitis obliterans syndrome compared to patients who did not (P = 0.007). The development of bronchiolitis obliterans syndrome and obliterative bronchiolitis were both correlated to observation time post-transplant but not to the number of rejections or infections when corrected for observation time. CONCLUSIONS: In a subgroup of lung transplant patients, a process in the transplanted lungs, eventually leading to bronchiolitis obliterans syndrome diagnosis, seems to start in the donor during the transplantation and/or in the early post-operative cause. A comparison with results after bilateral lung transplantation without bronchial artery revascularization suggests that good direct bronchial artery revascularization may postpone the onset of bronchiolitis obliterans syndrome and obliterative bronchiolitis. The positive trend motivates further use of direct bronchial artery revascularization in lung transplantation.

Adolescent↗

PubMed1999

Respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia: different entities or part of the spectrum of the same disease process?

OBJECTIVE: Our objective was to assess high-resolution CT findings of respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia and to determine whether these three entities could be reliably differentiated by radiologic criteria. MATERIALS AND METHODS: CT scans (1- to 3-mm collimation) were reviewed in 40 patients with pathologically proven respiratory bronchiolitis (n = 16), respiratory bronchiolitis-associated interstitial lung disease (n = 8), or desquamative interstitial pneumonia (n = 16). All patients with respiratory bronchiolitis and respiratory bronchiolitis-associated interstitial lung disease were cigarette smokers, and 85% of the patients with desquamative interstitial pneumonia had a history of smoking. CT scans were independently reviewed by two radiologists who assessed the pattern and distribution of abnormalities. RESULTS: The predominant abnormalities in respiratory bronchiolitis were centrilobular nodules (12 [75%] of 16 patients) and ground-glass attenuation (six [38%] of 16). No single abnormality predominated in the respiratory bronchiolitis-associated interstitial lung disease group; findings included ground-glass attenuation (four [50%] of eight), centrilobular nodules (three [38%] of eight), and mild fibrosis (two [25%] of eight). All patients with desquamative interstitial pneumonia showed ground-glass attenuation, and 10 (63%) of the 16 showed evidence of fibrosis. CONCLUSION: The significant overlap between the CT findings of respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia is consistent with the concept that they represent different degrees of severity of small airway and parenchymal reaction to cigarette smoke.

Adult↗

PubMed1998

A novel charcoal-induced model of obliterative bronchiolitis-like lesions: implications of chronic nonspecific airway inflammation in the development of posttransplantation obliterative bronchiolitis.

OBJECTIVES: In this study, we describe the development of a nonallogeneic animal model of obliterative bronchiolitis-like lesions. Furthermore, we examined whether chronic rejection alone can lead to the development of obliterative bronchiolitis or whether additional nonspecific airway inflammation is required. METHODS: Part I: Rats were intratracheally injected with 0.2 ml of activated charcoal or sorbitol solution (carrier for charcoal control). Animals were put to death beginning at 2 weeks up to 20 weeks. Part II: Animals were divided into three groups: group I, underimmunosuppressed Brown Norway to Lewis lung allografts; group II, charcoal-treated underimmunosuppressed allografts; and group III, charcoal-treated rats. Animals were put to death at 3 months after transplantation. RESULTS: Part I: In charcoal-laden bronchioles, subacute nonspecific airway inflammation was detected at 2 weeks. Slow, subclinical fibroproliferation ensued during the following weeks. Obliterative bronchiolitis-like lesions were observed in 80% of charcoal-treated animals at 12 weeks. Part II: Allografts developed extensive vascular lesions consistent with acute and chronic vascular rejection. Obliterative bronchiolitis-like lesions were scarcely detected. Charcoal-treated allografts demonstrated evidence of diffuse and severe obliterative bronchiolitis-like lesions. CONCLUSIONS: Transtracheal injection of activated charcoal into native lungs results in slowly progressive airway injury and inflammation leading to obliterative airway lesions. Inadequate immunosuppression primarily results in chronic vascular rejection but not obliterative bronchiolitis. Underimmunosuppressed allografts subjected to nonspecific airway inflammation develop obliterative airway lesions that are more prominent than in native lungs. This suggests that a cofactor to chronic rejection is likely necessary for the development of lung transplant obliterative bronchiolitis.

Animals↗

PubMed1997

Histopathological study of Sauropus androgynus-associated constrictive bronchiolitis obliterans: a new cause of constrictive bronchiolitis obliterans.

The development of constrictive bronchiolitis obliterans in patients who have ingested Sauropus androgynus juice has not been previously reported. We describe four patients with S. androgynus-associated constrictive bronchiolitis obliterans who underwent open lung biopsies for histopathological analysis. This article aims to recognize the possible pathogenesis of the disease. The spectrum of histologic changes ranged from slight bronchiolar inflammation and fibrosis to marked submucosal fibrosis causing complete cicatricial obliteration of the lumen. A dense eosinophil infiltrate was noted in the bronchiolar submucosa or fibrotic tissue of the completely obliterated bronchioles in two patients. Immunohistochemical studies revealed that lymphocytic infiltrate consisted mainly of T lymphocytes in all patients. Immunofluorescent stains for immunoglobulin (Ig)G, IgA, IgM, C1q, C3, and C4 were negative. Electron microscopy disclosed no immune complex deposition in the specimens examined. Although the role of antibody- and complement-mediated reaction is not supported by the negative results of immunofluorescent and electron microscopic studies, the common finding of the predominant T-lymphocytic infiltrate suggests that a T-cell mediated immune response is involved in the pathogenesis of the disease. Furthermore, the finding of a heavy lymphocytic infiltrate in many bronchioles without significant collagen deposition suggests that the lymphocytic infiltrate may precede the tissue fibrosis. In addition, the presence of a dense eosinophil infiltrate may combine with lymphocytes and other immunologic and mesenchymal cells to promote antigen-specific stimulation of lymphocytes and induction of fibrosis.

Adult↗

PubMed2001

Chronic bronchiolitis with associated eosinophilic lung disease (eosinophilic bronchiolitis).

We encountered an adult patient with dyspnea, eosinophilia and bronchiolitis. He was diagnosed as having diffuse panbronchiolitis, and was treated with erythromycin for 3 years, but his symptoms had gradually worsened. Bronchoalveolar lavage showed marked eosinophilia, and video-assisted thoracoscopic lung biopsy revealed chronic bronchiolitis with associated eosinophilic lung disease (eosinophilic bronchiolitis). To our knowledge, no case of eosinophilic bronchiolitis has been reported in the literature.

Bronchiolitis↗

PubMed1999

Nitric oxide production and absorption in trachea, bronchi, bronchioles, and respiratory bronchioles of humans.

Different volumes of dead-space gas were collected and analyzed for nitric oxide (NO) content, either immediately after inspiration or after a period of breath holding on clean air or NO mixtures. This allowed calculation of NO equilibrium, NO production, and NO absorption. In seven young, healthy, adult nonsmokers, the mean NO equilibrium values in parts per billion (ppb) were 56 +/- 11 (SE) in the trachea, 37 +/- 6 in the bronchi, 21 +/- 3 in the bronchioles, and 16 +/- 2 in the respiratory bronchioles. At any given NO concentration, the NO absorption rate (in nl/min) equaled the NO concentration (in ppb) times A (the absorption coefficient in l/min). A values (in l/min) were 0.11 +/- 0.01 in the trachea, 0.17 +/- 0. 04 in the bronchi, 0.66 +/- 0.09 in the bronchioles, and 1.35 +/- 0. 32 in the respiratory bronchioles. NO equilibrium concentrations and production rates in one 74-yr-old subject were three to five times as high as those found in the young subjects. Mouth equilibrium NO concentrations were 3 and 6 parts per million in two subjects who had oral production rates of 6 and 23 nl/min, respectively. In conclusion, production and absorption of NO occur throughout the first 450 ml of the airways.

Adult↗

PubMed2005

Nitric acid-induced bronchiolitis in rats mimics childhood Bronchiolitis obliterans.

BACKGROUND: Childhood bronchiolitis obliterans (CBO) is an infrequent but severe disease, characterized by persistent obstructive respiratory symptoms after an acute episode of bronchiolitis. Its etiology is mostly postviral, especially in developing countries. Pathologically, CBO is characterized as constrictive-type BO. The pathogenesis of this disease is poorly understood and there is no specific treatment. Animal models could help to better understand the sequence of events culminating in bronchiolar obliteration and serve as basis for experimental therapeutic research. OBJECTIVES: In this study, we adapted the nitric acid (NA) technique to develop a suitable model to study CBO in rats. METHODS: We have intratracheally instilled 0.5% NA or saline and studied the histological lesions on days 2, 7, 14 and 30. NA-instilled animals developed a sequence of bronchiolar lesions that included necrotizing bronchiolitis, proliferative (PROL) bronchiolar lesions and constrictive (CONS) bronchiolar lesions with bronchiectasis, mucostasis and macrophagic accumulation. RESULTS: The frequency of PROL lesions decreased and that of the CONS lesions increased, with a statistically significant difference at the sacrifice days, except for day 7 (PROL vs. CONS lesions day 2: p = 0.001; PROL vs. CONS lesions day 7: p = 0.38; PROL vs. CONS lesions day 14: p < 0.001; PROL vs. CONS lesions day 30: p < 0.001). CONCLUSIONS: We conclude that this model presents histological similarities with the histological picture of CBO, being suitable for further developmental and therapeutic experimental research in this field.

Animals↗

PubMed1993

Pathologic manifestations of bronchiolitis, constrictive bronchiolitis, cryptogenic organizing pneumonia, and diffuse panbronchiolitis.

This article reviews the histopathological findings in a variety of inflammatory bronchiolar diseases. The emphasis is on differentiating syndromes of idiopathic airflow limitation (constrictive bronchiolitis and diffuse panbronchiolitis) from cryptogenic organizing pneumonia (idiopathic bronchiolitis obliterans organizing pneumonia). The histopathological findings in each of these conditions are relatively nonspecific; therefore, it is imperative that pathological findings are correlated with clinical and roentgenographic information before a specific diagnosis is made.

Acute Disease↗

PubMed1997

Follow-up of children with respiratory syncytial virus bronchiolitis in 1986 and 1987: potential effect of ribavirin on long term pulmonary function. The Bronchiolitis Study Group.

BACKGROUND: Hospitalization for respiratory syncytial virus (RSV) bronchiolitis is considered a risk factor for reactive airway disease and/or abnormal pulmonary function tests (PFTs) later in childhood. This study attempted to assess this observation with newer PFTs and to determine whether ribavirin therapy of initial RSV infection may affect the long term outcome. METHODS: Medical records of all infants hospitalized with RSV infection in 1986 and 1987 at six institutions (North Shore University Hospital, Children's Hospital of Buffalo, University Florida-Gainesville, University of Connecticut, Children's Hospital National Medical Center, Denver Children's Hospital) were requested. Patients who could be contacted were recalled in 1993 and 1994 for PFTs and given a pulmonary status questionnaire. RESULTS: One hundred patients were evaluated. Overall PFTs were within normal ranges. There was less "bronchitis" over the interval years in the ribavirin-treated patients (13 of 33) vs. those who did not receive ribavirin (44 of 67, P < 0.01). There was no difference for the diagnosis of reactive airway disease (15 of 33 ribavirin vs. 36 of 67 no ribavirin). Patients who received ribavirin were then matched by age (within 2 weeks) at initial RSV infection and underlying risk factor (bronchopulmonary dysplasia, heart disease). Of the 27 patients matched, the ribavirin patients had longer intensive care unit stays (median (25 to 75% interquartile range): 2 (0 to 7) vs. 0 (0 to 0), P < 0.05). On follow-up evaluation there were no significant differences in PFTs or reactive airway disease between the 2 groups. There was a trend toward lower forced expiratory volume at 1 s and midexpiratory flow rate (25 to 75%) in the ribavirin-treated group, and there were more reported pneumonias on follow-up in the ribavirin patients. CONCLUSION: During our 5- to 6- year follow-up of children, status post bronchiolitis, we noted a good long term prognosis. No long term adverse effects on pulmonary function were detected. Despite being potentially sicker at presentation as assessed by intensive care unit stay, ribavirin recipients were doing equally well at the time of follow-up.

Antiviral Agents↗

PubMed2006

Risk factors for the development of bronchiolitis obliterans in children with bronchiolitis.

BACKGROUND: Bronchiolitis obliterans (BO) is an uncommon and severe form of chronic obstructive lung disease in children that results from an insult to the lower respiratory tract. METHODS: A case-control study of children under the age of 3 years was performed in 109 cases and 99 controls to determine risk factors for the development of BO. Participants were evaluated by immunofluorescence viral tests, pulmonary function tests, and questions to assess tobacco and other exposures. RESULTS: Bronchiolitis due to adenovirus (odds ratio (OR) 49, 95% confidence interval (CI) 12 to 199) and the need for mechanical ventilation (OR 11, 95% CI 2.6 to 45) were strongly and independently associated with an increased risk for BO. Factors not associated with post-infectious BO included age of the child, sex, and environmental tobacco exposure (either in utero or during infancy). CONCLUSIONS: Adenovirus infection and need for mechanical ventilation are significant risk factors for developing BO in children. Further research is needed to determine why these risk factors are so strong and how they may contribute to the development of the disease.

Adenoviridae Infections↗

PubMed2005

Lung transplantation biopsy specimens with bronchiolitis obliterans or bronchiolitis obliterans organizing pneumonia due to aspiration.

CONTEXT: Bronchiolitis obliterans (BO) is generally thought to be a marker of chronic airway rejection in patients who have undergone lung transplantation. Bronchoscopic biopsy specimens, by virtue of their small size, may sample only BO and not a lesion of bronchiolitis obliterans organizing pneumonia (BOOP). A role for ongoing chronic infection or aspiration has also been suggested, and the distinction of these etiologies may be difficult clinically and pathologically. OBJECTIVE: To investigate the etiology of BO and BOOP in lung transplantation patients who had chronic aspiration. DESIGN: This is a clinicopathologic study of 7 patients who had undergone lung transplantation in which biopsy findings suggested the possibility of chronic airway rejection but in which aspiration was subsequently proven as a cause of the bronchiolar disease. RESULTS: All patients were men, who ranged in age from 19 to 57 years. A clinical diagnosis of aspiration was considered based on history, acid reflux testing, and radiographic findings in all 7 patients. Three patients had BO and 4 patients had BOOP. Histiocytic giant cells or foreign material was absent. The interval from transplantation to BO ascribed to aspiration ranged from 2.5 months to 7 years. The patients were treated aggressively with medication for gastroesophageal reflux disease. Their respiratory function and chest radiography results improved. CONCLUSION: Although BO may be a manifestation of rejection, it may also be a manifestation of aspiration. Because the latter is potentially correctable, aspiration should be considered etiologically in lung transplantation patients with either BO or BOOP. Reliable distinction between aspiration-related or rejection-related BO and BOOP cannot be made on morphologic grounds alone. Clinical and radiologic correlations are indicated to establish the distinction.

Adult↗

PubMed2003

Bronchiolitis obliterans syndrome in lung transplant recipients: correlation of computed tomography findings with bronchiolitis obliterans syndrome stage.

The purpose of this study was to correlate the extent of computed tomographic (CT) findings with the severity of respiratory dysfunction in lung transplant recipients with bronchiolitis obliterans syndrome (BOS). Eighty-nine conventional and 61 thin-section CT scans performed in 44 transplant recipients (17 bilateral, 27 single) with BOS were reviewed for mosaic attenuation, degree of bronchial dilation, bronchial thickening, central and peripheral bronchiectasis, mucus plugging, and air trapping. Findings on conventional and thin-section CT scans were correlated with BOS stage for bilateral and single-lung transplant recipients. In bilateral-lung recipients, a significant correlation existed, although weak, between BOS stage and findings of degree of bronchial dilation (P < 0.01), bronchial wall thickening (P = 0.01), peripheral bronchiectasis (P = 0.01), and mosaic attenuation (P = 0.01) on conventional CT; and bronchial wall thickening (P = 0.01) and mosaic attenuation (P = 0.03) on thin-section CT. In single-lung recipients, BOS stage correlated only with the finding of central bronchiectasis (P = 0.02) on conventional CT scans. No correlation was found between the extent of air trapping and BOS stage in either single- or bilateral-lung transplant recipients. CT findings are relatively poor indices of airflow obstruction in lung transplant recipients with BOS, particularly in those with single-lung transplants for emphysema.

Adolescent↗

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