Horng-Chin Yan

Evaluation of Risk Factors for Asthma in Taipei City

Background: Asthma has rarely been studied by evaluating all of its trigger factors in 1 study population. Thus, correlations between the concentration of allergen immunoglobulin (Ig) E antibodies and airway limitation or asthma severity remain unclear. Methods: Five hundred and seventy‐nine asthmatic patients were enrolled, and serum specific IgE antibodies to allergens were analyzed. All suspected trigger factors were assessed by questionnaire, case histories over a 4‐year period, and diary card recordings; possible trigger factors were then re‐evaluated. Results: Antibodies to the following allergens were found: Dermatophagoides pteronyssinus (59.8% of patients), D. microceras (58.8%), D. farinae (56.8%), cockroach (38.3%), dog dander (26.3%), Candida albicans (13.3%), cat dander (10%), and Cladosporium herbarum (6.6%). A greater prevalence of allergy to dog and cat dander was found than previously. Younger patients were more often positive for mite allergens, and had higher titers of antibodies against such allergens, than older patients. Further, females had a lower concentration of mite allergen antibodies than males. No correlation between the concentration of allergen antibodies and forced expiratory volume in 1 second (FEV1), or the ratio of FEV1:forced vital capacity (FEV1:FVC), was found. In addition, there was no significant change in antibody titers with varying asthma severity. Non‐allergenic trigger factors were irritant air inhalants (94.6% of patients), respiratory infection (92.2%), exercise (75.2%), emotional factors (58.8%), drugs and chemical substances (16%). Conclusion: There are multiple trigger factors in asthma. Allergenic trigger factors are more common in younger than older patients, whereas non‐allergenic trigger factors are more common in older patients. There was no linear correlation between the concentration of specific IgE antibodies and asthma severity or airway limitation; therefore, to prevent asthma attacks in individual asthmatic patients, greater attention should be paid to avoiding all potential trigger factors, and not just house dust mite allergens.

Use of anti-(tumour necrosis factor-α) antibody or 3-deaza-adenosine as additives to promote protection by University of Wisconsin solution in ischaemia/reperfusion injury

Experimental interventions that reduce ischaemia/reperfusion (I/R) lung injury can be used to improve the properties of preservation solutions. We attempted to increase the attenuation of I/R injury by University of Wisconsin solution (UW) by adding an antibody against tumour necrosis factor-alpha (TNF-alpha), to neutralize TNF-alpha, and/or by adding 3-deaza-adenosine (c3-Ado), to inhibit leucocyte adhesion and the biosynthesis of ICAM-1 (intercellular cell-adhesion molecule 1). We examined I/R injury using an isolated rat lung model. Six different solutions were perfused individually, followed by evaluation of I/R injury: (1) 0.9% NaCl (normal saline; NS), (2) NS+anti-TNF-alpha antibody, (3) UW alone, (4) UW+anti-TNF-alpha, (5) UW+c3-Ado and (6) UW+anti-TNF-alpha+c3-Ado. Haemodynamic changes, lung weight gain, capillary filtration coefficient, TNF-alpha levels and lung pathology were analysed in order to evaluate I/R injury. Compared with lungs perfused with NS, lungs treated with NS+anti-TNF-alpha showed less I/R injury. The addition of anti-TNF-alpha and/or c3-Ado to UW reduced I/R injury compared with unmodified UW. Among the six solutions tested, UW containing anti-TNF-alpha antibody reduced I/R injury to the greatest extent. We conclude that addition of anti-TNF-alpha antibody or c3-Ado protects against I/R lung injury when using UW. Further investigation of the improved properties of modified UWs would be beneficial with regard to lung transplantation research.

Role of Open Lung Biopsy in Patients with Diffuse Lung Infiltrates and Acute Respiratory Failure

BACKGROUND AND PURPOSE Open lung biopsy (OLB) is the standard procedure for the diagnosis of specific parenchymal lung diseases. The purpose of this study was to investigate the influence of OLB on subsequent treatment strategy and outcome in patients with diffuse lung infiltrates and acute respiratory failure. METHODS This retrospective review included 32 patients (aged 50.6 +/- 21.7 years) with acute respiratory failure and diffuse pulmonary infiltrates who underwent OLB from 1990-2002. Data analyzed included diagnoses, treatment alterations, 30-day survival, oxygenation status, and histologic results. RESULTS Specific diagnoses were made in 53.1% of patients (17/32), 23 (71.9%) of whom had acute respiratory distress syndrome (ARDS). Diagnostic yields did not differ with immunity status or ARDS. OLB led to specific decisions of treatment in 46.9% of patients (15/32), and only 7 of these 32 patients (21.8%) survived. Overall mortality was 56.2% (18/32) and was not influenced by pre-OLB oxygenation or histologic results. Although perioperative complications affected 40.6% of patients (13/32), none of the deaths were surgery-related. Complication rates were significantly higher in patients with ARDS (p = 0.04). CONCLUSIONS OLB is associated with a low perioperative mortality rate and acceptable morbidity rate in patients with diffuse lung infiltrates and acute respiratory failure, including those patients with ARDS. In this study, a specific diagnosis was obtained by OLB in more than half of patients with diffuse pulmonary infiltrates and ARDS. In addition, OLB resulted in either use of a new therapeutic strategy or elimination of unnecessary treatment in nearly one-half of patients (46.9%).

Squamous Cell Carcinoma of the Lung Following Adult-onset Recurrent Respiratory Papillomatosis

Malignant transformations of recurrent respiratory papillomatosis (RRP) are rare, and are usually associated with prior radiation therapy or a history of smoking. In this report, we describe an uncommon case of a 54-year-old woman with no history of either irradiation or active smoking, who developed squamous cell carcinoma of the lung from adult-onset recurrent respiratory papillomatosis (AO-RRP) with lung involvement in the 10-year follow-up period. Serial chest radiographs and computed tomography scans showed widely scattered parenchymal lesions, both solid and cavitary, central and peripheral. The lung lesions grew slowly and some became confluent. To the best of our knowledge, squamous cell carcinoma of the lung is a rare complication of RRP without a history of irradiation or smoking.

Bilateral Pulmonary Sclerosing Hemangiomas: A Case Report

We present a rare case of bilateral pulmonary sclerosing hemangiomas. The patient underwent computed tomography (CT)-guided biopsies along with a pathological examination and immunohistochemical studies, and was diagnosed accurately without surgical intervention. The related literature is reviewed.

Desquamative Interstitial Pneumonitis-A Case Report and Literature Review

Desquamative interstitial pneumonitis (DIP) is a subgroup of interstitial lung disease that has a distinctive histopathology, with macrophages filling the alveolar spaces and no significant fibrosis. DIP has a strong association with cigarette smoking, and a better prognosis and response to corticosteroid. We report a patient with introgenic Cushings syndrome who presented with progressive dyspnea and a bilateral diffuse ground-glass pattern on the chest roentgenograph, and who was diagnosed with DIP after video-assisted thoracoscopic (VATS) lung biopsy. Her condition was uneventful after treatment with corticosteroid. The development of DIP in this case may be associated with cigarette smoking and the abrupt discontinuation of the corticosteroid.